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Full text of "Design for aging : an architect's guide"

THE AMERICAN INSTITUTE OF ARCHITECTS 



DESIGN FOR AGING: 

An Architect's Guide 



Digitized by the Internet Archive 

in 2012 with funding from 

Boston Library Consortium Member Libraries 



http://archive.org/details/designforagingarOOamer 



DESIGN FOR AGING: 

An Architect's Guide 

The American Institute of Architects 



11 



The American Institute of Architects advocates the design and construction of an 
environment in which people will be able to enjoy a full life span with a minimum of 
dependence on others. 




R. Bruce Patty, FAIA, President 
The American Institute of Architects 



Ill 



DESIGN FOR AGING: 

An Architect's Guide 



The AIA Foundation 
The AIA Press - Publisher 
Washington, D.C. 




IV 



Copyright© 1985 by The American 
Institute of Architects Foundation. 
All rights reserved. No part of this book 
may be reproduced, stored in a retrieval 
system or transmitted in any form by 
any means without prior written permis- 
sion of the publishers. 

Published in the United States of 
America by The AIA Press, 1735 New 
York Avenue, N.W., Washington, D.C. 
20006. 

ISBN 0-913 962-77-5 



Library of Congress Cataloging in 
Publication Data: 

Main entry under title: 

Design for Aging: An Architect's Guide. 

"An AIA Press publication." 

Includes bibliographical references and 
index. 

1. Buildings — Aging. 2. Architec- 
ture — Aging. 



I. The AIA Foundation 



85-73625 



SPONSORS 



AIA Catalog Number: R347^ 



This document was made possible by 
grants from the Administration on 
Aging, (AoA), U.S. Department of 
Health and Human Services (Grant No. 
AoA-90-AT-0080), the National Endow- 
ment for the Arts (NEA) (Grant No. 
DC A 84-78) and the American Institute 
of Architects. 



The statements contained in this docu- 
ment are those of the AIA Foundation 
and do not necessarily reflect the views 
of the foregoing sponsors. The sponsors 
and the AIA Foundation make no war- 
ranty, express or implied, and assume 
no responsibility for the accuracy or 
completeness of the information herein. 



"On behalf of the AIA Task Force on Aging, I wish to dedicate this publication to my 
friend, Thomas O. Byerts, AIA, (1942-1984), a pioneer in the field of design for 
aging. During his 10 years as the Director of Housing and Environment with the 
Gerontological Society of America in Washington and later as Director of the 
Gerontological Center of the University of Illinois in Chicago, he was an effective 
advocate for a physical environment sympathetic to the needs of older people. A 
recipient in 1983 of the American Institute of Architects Presidential Citation, Tom 
Byerts' contribution to the quality of life of the elderly population has been recognized 
by his peers." 



Edward Henry Noakes, FAIA 



Vll 



CONTENTS 



Page 

Acknowledgments ix 

Preface xiii 

Part I: Introduction — Aging and the Environment 1 

Stereotypes 2 

Demographics 4 

Narrowing Capabilities 5 

Physical Changes 6 

Psychological Changes 9 

Social Changes 10 

Part II: Facility Types 13 

Continuum of Care 14 

Elderly Housing 17 

Senior Centers 26 

Residential Care Facilities 32 

Nursing Homes 40 

Continuing Care Retirement Communities 50 

Part III: A Design for Aging Glossary 59 

Appendices 149 

A: Annotated Bibliography 149 

B: Design for Aging Information Network 167 

C: Barrier- free Standard Back 

Insert 

Index 171 



IX 



ACKNOWLEDGMENTS 



This document is a result of the efforts 
and support of many individuals and 
organizations concerned directly and 
indirectly with design for aging. At an 
exploratory meeting convened at The 
American Institute of Architects in June 
1982 and attended by many of the indi- 
viduals on the Advisory Committee 
(whose members are listed below), the 
need for an architectural guide on design 
for aging was identified. A Task Force 
on Design for Aging was then appointed 
by the AIA to support the proposed pro- 
ject and help make it a reality. Task 
force members, who have given gener- 
ously of their time and expertise 
throughout the course of this project, are 
listed below. 

AIA TASK FORCE ON AGING 

Martin H. Cohen, FAIA 

Armonk, N. Y., chairman 

Samuel A. Anderson, AIA 
Glave/Newman/ Anderson P . C . 
Richmond 

Walter E. Burgess, AIA 

Walter E. Burgess AIA & Associates 

Colorado Springs, Colo. 

Walter Hackler, AIA 
Thomas Jefferson University 
Philadelphia 

Edward H. Noakes, FAIA 
Noakes Associates, Bethesda, Md. 

R. Stanford Woodhurst Jr., AIA 
Woodhurst Partnership-Architecture 
Augusta, Ga. 

Maurice Payne, AIA 
American Institute of Architects 
Washington, D.C., task force staff director 



ADVISORY COMMITTEE 

Representatives of a number of private- 
and public-sector organizations have 
served as an advisory committee for this 
project. They are Leo Baldwin of the 
American Association of Retired Per- 
sons; William Koffel of the American 
Health Care Association; Robert Graeff 
of the Architectural Research Centers 
Consortium; Edwin Marcus of the Fed- 
eral Council on Aging; Carol Schutz and 
Adrian Walker of the Gerontological 
Society of America; George Genung of 
the National Association of Home 
Builders; John Salmen of the National 
Center for a Barrier Free Environment; 
Robert Cosby of the National Council 
on Aging; Paula Terry of the National 
Endowment for the Arts; James Bell of 
the National Fire Protection Association; 
Keith Suerdick, AIA, of the U.S. 
Department of Agriculture; Carole 
Dingeldein and Harry A. Rosenzweig of 
the U.S. Department of Health and 
Human Services, and Judy Mabry of 
the Veterans Administration. 

Together, the AIA Task Force on 
Design for Aging, the technical reviewers 
and the advisory committee have pro- 
vided invaluable assistance in the devel- 
opment of this document. Special thanks 
go to Edward Noakes for his generous 
contribution of source material. Special 
thanks are also due Paula Terry of 
NEA, Maurice Payne of the AIA and 
Carole Dingeldein of the Administration 
on Aging, for their support and 
guidance on this project. 



Acknowledgments 



TECHNICAL REVIEW 

In addition to technical reviews by the 
AIA Task Force on Design for Aging 
and other AIA units (see below), this 
document has benefited greatly from 
review in draft form by: 

Sandra C. Howell, Ph.D. 
Massachusetts Institute of Technology 
Cambridge, Mass. 

Leon A. Pastalan, Ph.D. 
University of Michigan 
Ann Arbor, Mich. 

Victor A. Regnier, AIA 
University of Southern California 
Los Angeles 

Edward Steinfeld, AIA 

State University of New York 

Buffalo 

John Zeisel, AIA 
Building Diagnostics Inc. 
Boston 



Members of the AIA Housing Commit- 
tee who have reviewed this document in 
draft form are R. Blake Chambliss, 
AIA, Chambliss Associates, Grand Junc- 
tion, Colo.; Philip S. Handler, AIA, 
Handler Associates Architects Inc., West 
Hartford, Conn.; Thomas W. Tilsley, 
AIA, PDT & Company Architects/Plan- 
ners, Cincinnati; Ortrude S. White, 
AIA, Niles Bolton Associates, Atlanta, 
and Richard H. Slater, AIA, Washing- 
ton, D.C. 

Members of the AIA Committee on 
Architecture for Health's subcommittee 
on Design for Aging who have reviewed 
this document are Albert Miotto, AIA, 
Veterans Administration, Bowie, Md.; 
Merwyn Croston, AIA, Parker/Croston 
Partnership, Fort Worth, Tex.; John 
Whitney, AIA, Medifac Architects Inc., 
Pennsauken, N. J., and Bill Blair, AIA, 
C.H. Guernsey & Company, Oklahoma 
City, Okla. 

Members of the federal interagency Task 
Force on Design for Aging who have 
reviewed this document are Drew 
Allbritten and Mary Ann Gomez of the 
U.S. Department of Housing and Urban 
Development; Diane Freeman of the 
U.S. Department of Health and Human 
Services; Keith Suerdick and Sue Harris 
of the Farmer's Home Administration, 
USDA, Paula Terry and Charles 
Zucker, of the National Endowment for 
the Arts. 



XI 



Acknowledgments 



LITERATURE SOURCES 

The annotated bibliography in this docu- 
ment indicates sources for much of the 
information presented here. Three vol- 
umes merit special citation because of 
their especially extensive use: 

Joe J. Jordan. Senior Center Design: An 
Architect's Discussion of Facility Planning 
(Washington, D.C.: National Council 
on Aging, 1978). 

J. A. Koncelik, Designing the Open Nursing 
Home (Stroudsburg, Pa.: Dowden, Hut- 
chinson & Ross, 1976). 

Michigan State Housing Development 
Authority, Housing for the Elderly Develop- 
ment Process (Lansing, Mich.: MSHDA, 
1974). 



AIA FOUNDATION 
PROJECT STAFF 

Mary C. Means, president 

Alexander T. Shaw III, 
program director 

Craig W. Hoellwarth, program director 

Gail Farris, research assistant 

Paul McClure, technical editor 

Sheri D. Bergen, Lisa Moore 
and Vicki Walker Shunk, 
administrative assistants 

LasEric Patterson, word processing 

PROJECT CONSULTANTS 

Paul S. Taylor, Designs for Aging, 
Bethesda, Md., expert on aging 

Kevin W. Green, Green & Associates, 
Washington, DC, editorial consultant 

Rick Vitullo, Darrel Downing Rippeteau 
Architects, Washington, DC, illustrator; 

Charlotte S. Wade, Wade Associates, 
Tuscon, Ariz.; William Starr, Assarsson 
Design, Washington, D.C., and 
M. Stephanie Stubbs, ArchiSearch, 
Arlington, Va. 



Xlll 



PREFACE 



The demographic projections are clear: 
America's already sizeable elderly 
population is increasing dramatically 
both in numbers and as a percentage of 
the nation's overall population, and it 
will continue to do so for the next quar- 
ter-century and beyond. From an archi- 
tectural viewpoint, such projections lead 
to at least one equally clear conclusion: 
The market for design services keyed to 
meeting the needs of aging Americans is 
quickly becoming a great deal more 
substantial. 

But this conclusion raises a number of 
important questions for every architect 
who hopes to respond to this growing, 
specialized market. How specialized is 
it? Who are the aging? What are their 
environmental needs? And what do we 
know about meeting those needs? 

This book is designed to answer those 
questions for the practicing architect. It 
is a ready-reference work, expected to 
occupy a place alongside the program- 
mer's desk and the designer's drawing 
board. It is not a comprehensive treat- 
ment of the field; the literature on design 
for aging comprises many, many vol- 
umes, and the most pertinent and useful 
of them are cited here in an annotated 
bibliography to encourage and facilitate 
further research. Nor does this text 
anticipate the context of every design 
problem that will arise. Its recommenda- 
tions have a general application that 
must, as all design guidelines must, be 
weighed with keen professional judg- 
ment. Written to be used in conjunction 
with current and applicable codes and 
standards, the standard architectural ref- 
erence works and other, more detailed 
references, this book is a practical guide 



to the physical, psychological and social 
realities of aging, and to the design 
issues that an architect working with 
those realities will encounter. 

The group of users typically called the 
aging is characterized by a broad spec- 
trum of special needs, preferences and 
limitations. This book accepts that tradi- 
tional understanding to a certain extent. 
It addresses the range of changes gener- 
ally experienced by people in the later 
years of their lives; but it also recog- 
nizes, as should every architect, that 
exceptions are the rule in this user popu- 
lation. For example: The vast majority 
of elderly Americans typically experience 
only one or two of the many problems 
that threaten us all as we grow old; and 
unless specifically limited by one of those 
problems, the vast majority remain in 
many ways competitive with their 
younger colleagues well into their senior- 
ity. Further, the problems don't magi- 
cally occur at 65, 70 or any other partic- 
ular age. Their onset can result from 
any of an infinite number of variables, 
and can do so at almost any time — 
witness the midcareer architect who is, 
in all probability, only a few years away 
from needing the bifocals that serve as 
one of our earliest reminders of the inev- 
itability of aging. 

The aging are not fundamentally differ- 
ent from any other user group; their 
needs are subject to change over time, 
and characterized by tremendous vari- 
ety. By the same token, design for aging 
is not fundamentally different from any 
other sort of design. It can be, however, 
substantially more challenging, precisely 
because the dynamism and variety of its 
user group tend toward extremes. In few 



XIV 



Preface 



PREFACE 



O 



PARTI 

INTRODUCTION: 
AGING AND THE 
ENVIRONMENT 



^> 



PART II 
FACILITY TYPES 



ELDERLY HOUSING 



SENIOR CENTERS 



RESIDENTIAL CARE 
FACILITIES 



NURSING HOMES 






CONTINUING CARE 
RETIREMENT CENTERS 














PART III 
GLOSSARY 






£ 






APPENDICES 











Using the Book. The book was designed to facilitate the cross referencing between the Glossary 
and Facility Types which will be necessary. 



other fields of architecture, for example, 
does an architect know that within the 
same user population there may be indi- 
viduals with no major limitations, and 
others who have partial limitations 
involving every sense, every decision, 
every movement. 

Design for Aging: An Architect's Guide is 
divided into several parts. As a reading 
of Part I — an introduction to the aging 
and their environment — illustrates, 
design for aging poses a set of param- 
eters that is simultaneously as vast and 
as narrow as any other an architect will 
encounter. Part I should be considered 
required reading by every user of this 
guide, because it both provides essential 



background on the elderly and sets out a 
design approach that differs sufficiently 
from traditional approaches to have pro- 
vided the title of this book. This 
approach rests on the notion that a basic 
difference exists between design for the 
aging and design for aging. The former 
assumes a certain user population — the 
aging — with certain static behavioral pat- 
terns, needs and limitations to be 
addressed in design. The latter assumes 
a changing condition, not a user popula- 
tion per se but a process. This guide is 
entitled Design for Aging because a static 
user population simply does not exist. 
Aging is indeed a universal process; it 
affects each of us and continues for as 
long as we live, which is why good 



XV 



Preface 




design for aging can and should be 
thought of as good design for all ages. 

Parts II and III are specifically designed 
for use during programming and design. 
Part II defines the continuum of care 
required by the aging and identifies the 
important site, space, use and design 
considerations for the five most common 
facility types associated with older users: 

• elderly housing 

• community and senior centers 

• residential care facilities 

• nursing homes 

• continuing care retirement centers 

Part II also provides a typical plan for 
each facility type, an adjacency matrix, 
and a design and programming check- 
list. The checklists enumerate issues 
"from the outside in" — from the overall 
site to the individual user's space. In 
addition, Part II outlines "the contin- 
uum of care," and diagrams the spec- 
trum of recognized facility types devel- 
oped to date, so the architect may deter- 
mine where a project fits in this spec- 
trum and interpolate project-specific 
checklist and adjacency requirements 
accordingly. 



The checklists also provide access to Part 
III, a detailed glossary that defines and 
discusses each aging-specific item listed 
in the checklists. Items deemed "nonag- 
ing specific" are not referenced in the 
glossary; these items should fall within 
the purview of the standard architectural 
references and are assumed to be part of 
the architect's general understanding and 
expertise. 

Parts II and III are designed for quick, 
easy reference during programming and 
design; an architect charged with site 
design for an elderly-housing project, for 
example, will find aging- related site 
issues in the elderly-housing checklist, 
and find a definition and discussion of 
each issue at a specified location in the 
glossary. 

Design for Aging: An Architect's Guide also 
includes an annotated bibliography and 
two appendixes. The bibliography is a 
guide to references selected for their par- 
ticular relevance to design for aging 
references that contain information . 
important to practitioners engaged in the 
field, but beyond the scope of this 
publication. 

Appendix A lists the key words that pro- 
vide access to the Design for Aging 
Information Network, the computerized 
data base developed by the AIA Founda- 
tion and accessed through the AIA 
Information Center, in which informa- 
tion about practice-relevant references on 
design for aging is maintained as a ready 
resource for architects. 

Appendix B is an accessibility standard 
presented in the form of a replaceable 
insert, and located in a storage pocket 



XVI 



Preface 



located inside the back cover of this 
book. ANSI A117.1 is frequently refer- 
enced in this book. The architect should 
be aware that some clients (especially 
governmental clients), financing agencies 
and local jurisdictions have adopted 
other barrier- free standards, such as the 
Uniform Federal Accessibility Standards 
(UFAS). In addition, ANSI A117.1 itself 
is currently undergoing revision at the 
American National Standards Institute, 
and an update may become available 
shortly after publication of Design for 
Aging: An Architect's Guide. The architect 
should replace the original insert, to 
keep Appendix B current and pertinent 
to the project at hand. Familiarity with 
ANSI A117.1, and similar barrier-free 
standards, is essential for any architect. 



However, although ANSI A117.1 and 
similar barrier-free standards have great 
applicability to the design of facilities for 
older users, they do not constitute the 
complete body of reference for the field 
of design for aging. Barrier-free design is 
fundamental to design for aging, but 
there are many other issues involved as 
well. 

The sheer challenge of designing for 
such a diverse user group — and the per- 
sonal recognition that each of us will 
eventually either join its ranks or expire 
in the attempt — should prompt in every 
architect an approach to design for aging 
that is as vigorous and dynamic as life 
itself. 



I 1 



I INTRODUCTION 



Aging and the Environment 



The year 1980 was clearly a watershed 
year in this country: The United States 
elected the oldest president in its history, 
and, for the first time, the percentage of 
American heads of household aged 65 or 
older surpassed the number of those 
aged 30 or younger. 

Whether or not a direct connection exists 
between them, these two facts are part of 
a growing body of evidence that estab- 
lishes one point beyond argument: The 
age curve of American society is rapidly 
changing shape. 

CONSIDER: 

• The age of the average American 
jumped more than six months — from 
31.3 years to nearly 32 — in just two 
years, from 1980 to 1982. 

• As of July 1, 1983, Americans over 65 
outnumbered American teenagers for 
the first time in the nation's history. 

• By 1990, there will be four million 
more Americans over 65 than there 
were in 1980. America's population will 
have tripled since 1900, but the number 
of Americans over 65 will have 
multiplied eight times. 

• By the year 2030, after the last of the 
baby boom generation (the generation 
born between 1947 and 1964, when 
more than four million births were 
recorded every year) has passed age 65, 
Americans over 65 will have increased 
from 11 percent of 1980's population to 
18.3 percent of a significantly larger 
population, and they may account for 
nearly one of every five Americans. 

The U.S. Consumer Products Safety 
Commission recently estimated that the 
United States spends $2 billion a year on 
therapeutic and rehabilitative health care 
resulting from falls and burns suffered 
by the aging in their own homes. One of 



the conclusions prompted by that esti- 
mate is that architects should design the 
houses that most people purchase in 
their 30s with an eye toward the phy- 
sical, mental and social changes those 
home buyers will experience in their 
later years. 

That may be an unlikely architectural 
notion, to impose the limitations of age 
and infirmity on the youthful aspirations 
of home buyer and architect alike. After 
all, it's only human nature to defer con- 
sideration of those long-term "changes" 
for as long as possible. But that notion 
does a lot to expose the reality of aging 
and the environment — a reality that is 
always complex, often contradictory and 
largely obscured when we think of aging 
solely in terms of an elderly population 
with a fixed set of limitations for whom 
special environments must be designed. 



Millions 
350 — 



165+ 



All Ages 



300 
250 
200 
150 
100 







f=r- 

— 




- 
1 — k\ r 11 r ii ii 

1 ______ 



1900 1920 1940 1960 1980 2000 2020 2040 



Elderly As a Percentage of Total U.S. 
Population. By the year 2000, there will be 
51 million more Americans than in 1980. 
The population of the United States will have 
increased 3.5 times since 1900. Moreover 
there will be 11.5 times more Americans 
over 65. 



2 I 



Introduction 



Good design for the aging is good design 
for people of all ages, not only because it 
provides improved commodity as time 
passes by, but also because design for 
aging increases control over the built 
environment for users of any age or 
ability. All private and public spaces 
should be designed to accommodate 
aging, if for no other reason than to be 
more universally accessible. 

The reality of aging is, above all else, 
dynamic. Aging is a process that begins 
at birth and continues unabated until 
death. Who, then, are the aging? Statisti- 
cians tend to use age 65 as the line of 
demarcation, but many Americans in 
their late 60s are as vital and as healthy 
as people 20 years younger. Even if we 
limit our definition of the aging to those 
who have begun to feel the inevitable 
debilitating effects of time, we are still 
dealing with a vital, changing population 
of individuals who span an age range of 
40 or 50 years, and who live and work 
in a wide range of environments with an 
even wider variance of functional capa- 
bilities. Yet stereotypical views of the 
elderly portray little of this dynamism or 
variety. 

STEREOTYPES 

Like the nation itself, America's 
stereotypical view of its elder citizens has 
changed radically over the past two cen- 
turies. Early in our history, people who 
lived to advanced age were rare; perhaps 
as a result, their advice and consent 
were sought and their wisdom generally 
respected. From roughly 1865 to the 
passage of the Social Security Act in 
1935 — and as longer life spans became 
more common — such negative attributes 
of age as infirmity, dependence and 



"senility" drew increased attention, and 
the image of the elderly tarnished. 

Since 1935, as the percentage of elderly 
Americans has continued to grow, so has 
interest and concern for both the prob- 
lems and contributions of aging Ameri- 
cans. Yet the work ethic that places a 
premium on productivity and 
youth — and often dictates a policy of 
mandatory retirement at 70 or 
sooner — has worked steadily against the 
elderly. The image of aging in America 
today is still one of heightened infirmity 
and dependence. 

It is problematic to extend this broad- 
brush portrait of our view of the elderly 
into the future, because so little can be 
projected with certainty. Some projec- 
tions are certain: We know, for example, 
that the baby boom of 1947-64 will 




1900 1920 1940 1960 1980 2000 2020 2040 



Percentage of Population over 65. The over 
55 population increased from 9 percent in 
1900 to 21 percent in 1980. It will take a 
dramatic leap early in the next century. 



I 3 



Stereotypes 



Not in Households 2.2% 

In Households 97.8% 

Living Alone 34.2% 

With Someone Else 16.2% 



Spouse Present 47.3% 




Not in Households 11.7% 

In Households 88.3% 
Living Alone 45.1% 

With Someone Else 23.8% 



Spouse Present 19.3% 




FEMALE 65-74 



FEMALE 75+ 



Not in Households 2.1% 

In Households 97.4% 

Living Alone 11.1% 

With Someone Else 7.8% 



Spouse Present 79.0% 




MALE 65-74 



Not in Households 7.1% 

In Households 92.9% 

Living Alone 19.0% 

With Someone Else 9.1% 



Spouse Present 64.8% 




MALE 75 + 



Living Arrangements of the Elderly (1981). Ninety percent of Americans 65 and over live in 
household settings; homes, town- homes and apartments. Variations occur between the sexes 
with increasing age; e.g., 45 percent of women over 75 live alone while only 19 percent of men 
over 75 do. 



shortly become the aging boom of the 
early 21st century, with both the number 
and percentage of elderly Americans 
reaching unprecedented levels. Other 
projections are less certain: Although we 
know, for example, that life expectancy 
in America has increased substantially in 
the last half-century, we also know that 
that increase is due in large measure to 
our reductions of infant mortality and 
death from non-age-related diseases. 
Longer lives aside, we know very little 



about how healthy or capable the aging- 
boom generation will be, say, 20 years 
after it cashes its individual retirement 
accounts. The closest we can come is to 
take a statistical look at today's aging 
Americans and assume a degree of com- 
parability for tomorrow's. 



4 I 



Demographics 



DEMOGRAPHICS 

A look at the research on America's 
aging provides a glimpse of a population 
at least as diverse as any other American 
subgroup. 

• Eighty percent of Americans aged 65 
and over live independently in their 
own houses and apartments. 

• Eighty percent of those living indepen- 
dently own their own homes. 

• More than 65 percent of Americans 
aged 65 and over live in family settings, 
with spouse, children or other relatives. 

• Only five percent of Americans aged 65 
and over are nursing home residents at 
any given time, and only 20 percent 
will live in a nursing home at any time 
during their lives. The average age at 
entry is 82. 

• In 1980, there were 150 females aged 
65 and over for every 100 males aged 
65 and over. Older women are gener- 
ally more likely to be widowed and liv- 
ing alone, and more likely to occupy 
facilities for the elderly; older men are 
more likely to be married and living 
with their wives. 

• While still in the workplace, older work- 
ers are absent less frequently, use 
psychotropic drugs less often, show 
lower rates of admission to psychiatric 
facilities and report less stress than 
younger workers. 

• Despite the facts that the median 
income of Americans aged 65 and over 
is half that of the average family, and 
that many live on fixed incomes, older 
Americans qualify as big consumers. 
Accumulated assets, regular retirement 
income and generally low financial 
responsibilities combine to produce 
generally high levels of discretionary 
income. 



Clearly, the aging present as great a 
cross section of capabilities, perceptions 
and environmental expectations as 
Americans in any other group. Widely 
divergent characteristics of health, 
wealth, cognitive skills, strength, status, 
ego and social performance are all likely 
to be encountered; and an architect 
designing for such a remarkably hetero- 
geneous population must recognize it as 
such. 

Yet an architect designing for this popu- 
lation must also design for the "worst- 
case scenario" — for the individual user 
who is least able to adapt to his or her 
environment — as well as for individuals 
at the "better" end of the population's 
spectrum. The architect must recognize, 
too, that this population's users can 
move from the capable end of the spec- 
trum to the incapable end in a relatively 
short time, and perhaps move back 
again. People change, as the saying 
goes, but buildings don't (at least not 
inexpensively); hence, the argument for 
flexible home designs that will be as effi- 
cient for aging users as they are for their 
youthful purchasers. 

Some will argue that flexibility and 
adaptability are expensive. But is a satis- 
factory alternative available? If we do 
nothing, if we merely maintain the status 
quo and continue to generate throwaway 
living environments that individuals 
must abandon when they can no longer 
manage their daily lives in those environ- 
ments, we will have perpetuated a sys- 
tem that is itself too expensive to sur- 
vive. The premature and potentially 
unnecessary abandonment of traditional 
homes and neighborhoods in favor of 
"easy living" arrangements free of bar- 



I 5 



Narrowing Capabilities 



riers and the introduction of support ser- 
vices from care-givers to compensate for 
the physical constraints of inflexible or 
unadaptable residential units drive up 
the costs of both housing and support 
services. Total replacement costs more 
than retrofit (see discussion on Page 64). 
and abandoned housing is a potential 
problem in any context, urban or rural. 
Thus, we will continue saddling the 
decreasing percentage of our population 
known as productive wage earners with 
the increasingly difficult and expensive 
task of providing for the needs of an 
expanding percentage of the population 
known as the elderly — an inherently 
bankrupt policy. Design for aging poli- 
cies that aim at facilitating the indepen- 
dent-life-style aspirations of the elderly 
also serve the best interests of both the 
individuals contributing to and enjoying 
the benefits of a free society and of that 
society as a whole. 

Essentially, the architect designing for 
the vast parameters of aging is called 
upon to create three basic kinds of 
environments: 

• Common spaces that are sensitive to the 
changing needs of the aging in the 
workplace and in the community, and 
thus prolong the productive economic 
and social life of America's maturing 
population; 

• Residential spaces that extend and maxi- 
mize independent living, and thus 
heighten quality of life and reduce 
dependence on the nation's health care 
and social service resources, and 

• Care facilities that are efficient and 
responsive to the needs of the elderly, 
and that improve care and perhaps even 
apply new concepts that may help to 



improve the quality of life and extend 
life itself. 

NARROWING CAPABILITIES 

Part of the dynamism of aging is the 
new-found opportunity for personal 
growth often discovered by older people 
who retire from daily work with the 
freedom to pursue long-delayed interests, 
and with the wisdom gained over a life- 
time of experience that can make those 
pursuits more rewarding. 

The other side of that dynamism is the 
very real toll taken by time. Our limita- 
tions grow as our years increase. With 
advanced age, our environmental needs 
become more complex, The likelihood of 
changes in familial, societal and occupa- 
tional roles increases. Losses of health, 
sensory acuity, independence and physi- 




liilll 1 1- 



Mobility and Reach. Physical capacities are 
diminished with advancing age, though in 
differing ways and at varying paces for each 
individual. 



6 I 



Narrowing Capabilities 



cad capability may also accompany 
advanced age. In environments designed 
to suit the elderly' s changed and chang- 
ing needs, however, individuals of 
advanced age can overcome many of 
these obstacles. As the aging individual 
is able to tolerate less insult from the 
environment, the environment becomes 
progressively more important to the indi- 
vidual's personal sense of orientation, 
well-being and general ability. By the 
same token, the architect's design chal- 
lenge grows as programmatic parameters 
narrow from the vast population of the 
aging to more-clearly defined kinds of 
individual users. 

How are the aging classified? One lead- 
ing specialist applies a nontechnical but 
entirely apt nomenclature to people in 
their later years. In this nomenclature, 
"go-gos" are people — perhaps recently 
retired — who are capable, active and 
eager to exploit their new-found free- 
dom. "Go-slows" are less capable or less 
eager to be so active. "No-gos" are 
generally incapable, physically or in 
other ways, of major activity. 

The beginning of this progression from 
"go-go" to "no-go" can occur at almost 
any time, depending on the individual. 
The order of the progression, however, 
is largely universal (though not irrever- 
sible), and transitions from one classifi- 
cation to another hinge on the age- 
related changes most of us experience in 
our later years. As an architect narrows 
his or her focus from the general aging 
population to the go-slows and no-gos, 
the need to make those transitions as 
smooth as possible for the user emerges 
as a key design goal. And to reach that 
goal, an architect needs to understand 



what those potential age-related 
changes — physical, psychological and 
social — may include. 

PHYSICAL CHANGES 

The physical changes experienced during 
the aging process generally involve 
mobility, strength and stamina, vision, 
hearing, and tactile and thermal sensitiv- 
ity. The degree of change experienced in 
each of those areas can vary widely, but 
dysfunction itself — however limited — can 
start a downward spiral into a larger 
sense of disorientation and vulnerability. 
Design can do a great deal to diminish 
that sense of disorientation and vulner- 
ability by providing the appropriate 
forms of physical support and behavioral 
cues. Sensory impairment, for example, 
does not necessarily mean that the 
elderly cannot absorb environmental 
information, but that they may require 
more reaction time and need clear, 
strong stimuli to compensate for the loss 
of sensitivity. The degree to which 
immediate surroundings promote or 
hinder appropriate action (and the sense 
of well-being that it imbues) depends in 
large part on the severity of sensory loss 
and on the combinations of impairments 
to more than one sense experienced by 
many older people. 

Mobility. A number of factors — many 
of them products of a lifetime of physical 
wear and tear — force many older people 
to do things more slowly. Gravity, for 
example, can gradually overcome our 
ability to stand perfectly erect, and the 
stooped posture of aging can itself cause 
difficulty in walking, sitting down, stand- 
ing up and turning. Reductions in 
ambulatory speed may be necessitated 
by a slowed reaction time; by low energy 



I 7 



Physical Changes 





*p 






* mm -jmmmmi i r 
Visual Acuity (Pair of Photographs). These photographs illustrate how the world may appear to 
an older person with impaired vision. 



levels resulting from such chronic condi- 
tions as heart disease; by inner-ear dam- 
age resulting in a loss of balance or poor 
feedback about the position of body and 
limbs; by losses of vision and hearing, 
which can decrease the information we 
need to move quickly and confidently 
through an environment, or simply as 
the result of a sedentary life style. 
In American society, the automobile 
may be more essential to mobility than 
the foot — and many elderly Americans 
continue to drive very late in life. Thus, 
an architect must design not only inter- 
ior environments that enhance mobilty 



(and decrease the likelihood of tripping 
or falling) but also building sites and 
roadways that take slowed reaction times 
into consideration, and sign systems 
keyed to limitations of sight. 

Strength and Stamina. Our fascination 
with jogging has taught us that strength 
may decrease with age, but that endur- 
ance — or stamina — stays relatively 
strong. When mobility is hindered, 
though, reduced strength and stamina 
are commonplace. Joints normally 
become more rigid with advancing age. 
Muscle strength and coordination 



8 I 



Physical Changes 



decrease. Overhead cabinets and shelves 
are suddenly beyond reach (which is 
why many interior walls in facilities for 
aging are designed with added support 
for mid-height storage). Round knobs 
may become hard to grasp and 
manipulate. And because movements 
that used to be simple may now require 
more exertion — more strength as well as 
stamina — distances in both interior and 
exterior layouts can become important 
considerations. 

Visual Acuity. Vision begins to decline 
as early as age 40, and long-term 
impairment can include loss of visual 
field and acuity, reduced color sensitivity 
and increased sensitivity to glare. Older 
people may require up to twice as much 
light as younger people to achieve equal 
visual acuity. Colors of similar intensity 
are more difficult to differentiate from 
one another, especially when viewed 
against similarly textured or reflective 
surfaces and when viewed under uniform 
lighting conditions. Pastels, very dark 
shades and combinations of blues and 
greens can be particularly difficult. 
These problems can be addressed in 
architectural design through increased 
illumination levels, increased size for 
signs, heightened contrast between ele- 
ments in all visually presented informa- 
tion, and the use of highly contrasting 
colors. 

Other visual changes occurring in the 
elderly include declines in the ability to 
see fine detail, to distinguish depth and 
to adapt to changes in brightness. Glare 
is often a major problem; the distraction 
it causes can affect balance, orientation, 
attention span and short-term memory. 
Glare is often caused by unshielded arti- 



ficial lighting or by direct sunlight when 
either beams into a reflective interior 
space. 

Hearing. Our hearing ability begins to 
decline noticeably even earlier than 
visual acuity does. Older people fre- 
quently find it most difficult to hear 
higher frequency sounds, such as those 
emitted by bells, and fire and smoke 
sirens. Designers should always consider 
redundant-cueing safety systems — sys- 
tems that issue alarms in both audible 
(in the right frequency) and visible 
modes, for example. 

A decline in hearing also typically makes 
it difficult for an older person to discern 
one voice or one sound against a back- 
ground of competing sounds or voices; 
thus, sound control becomes an impor- 
tant general design issue. 

Tactile and Thermal Sensitivity. Sen- 
sitivity to touch naturally and normally 
declines with advanced age because skin 
becomes drier and less elastic. Thus, 
subtle changes in environmental texture 
can go unnoticed by the older user. 
Smell — though not a tactile issue- — often 
declines with touch; sensitivity remains 
high enough, however, to make odor 
control important, particularly in envi- 
ronments in which incontinence may 
occur. 

Also important among the common tac- 
tile losses of aging are declines in imme- 
diate sensitivity to pain and temperature. 
The latter poses a dual threat, because 
the elderly can be both less aware of 
dangerous changes in temperature and 
less able to tolerate such changes. Many 
older people have a significantly nar- 



I 9 



Psychological Changes 



rower "comfort zone" than the young, a 
much-increased susceptibility to hypo- 
thermia (the lowering of overall body 
temperature to potentially fatal levels) 
and to frostbite at the extremities, and a 
reduced ability to recover from these 
conditions. Older individuals generally 
prefer more warmth in winter, are less 
able to endure extreme heat in summer 
and are particularly uncomfortable in a 
draft — especially when they are immo- 
bile and seated beside windows. 

PSYCHOLOGICAL CHANGES 

Research has suggested that the speed 
with which we process, store, summon 
and express information — not intel- 
ligence, per se — may decline with age. It 
requires little imagination to realize that 
such changes in perception, cognition 
and expression can have a depressing 
and perhaps debilitating psychological 
effect, even (or especially) when intelli- 
gence is still intact. 

These difficulties often lead to a general- 
ized sense of insecurity among older peo- 
ple. The reduced functioning of the sen- 
ses forces one either to negotiate an envi- 
ronment with less information or to limit 
one's activity in that environment. 
Neither is an attractive option; the 
former increases insecurity, and the lat- 
ter reduces the stimulation that we all 
find vital in daily life. 

The ability to adapt to a new environ- 
ment is related to one's capacity for 
exploring that environment and process- 
ing the new information it provides. 
Many older people have increasing diffi- 
culty creating new mental 
images — known as "cognitive 
maps" — of unfamiliar settings; their 



understanding of complex but familiar 
environments may be better than their 
understanding of less complex but unfa- 
miliar environments. 

Interestingly, older people may be more 
likely to find a cluttered spatial environ- 
ment — one in which objects close at 
hand provide visual stimulation, tactile 
involvement and memories of experi- 
ences and attachments to other 
people — more satisfying than any open 
and orderly spatial configuration. 

Most extreme cases of cognitive impair- 
ment used to be called "senility." 
Today, they are understood to fall into 
the range of organic dysfunctions that 
includes organic brain syndrome and 
Alzheimer's disease. A lengthy discus- 
sion of any of these dysfunctions 
— which are still being intensely 
researched — is arguably unnecessary for 
the designer, unless he or she is engaged 
in the design of highly specialized facil- 
ities. What is necessary for the designer 
is the realization that the vast majority of 
elderly people have little experience with 
such extreme dysfunction, and that the 
challenges of designing for this majority 
should be mastered before more extreme 
considerations come into play. This is 
not to dismiss what appears to be a sig- 
nificant problem for the elderly, how- 
ever. When perception and cognition are 
impaired by organic disease, the elderly 
individual can feel at odds with even the 
most familiar elements and cues in the 
environment, and have severe problems 
dealing with large, noisy, busy, complex 
and unfamiliar places. Special and sensi- 
tively designed spaces for the elderly who 
face these problems will figure more 
highly in design for aging as more is 



10 I 



Psychological Changes 



learned about both the problems and the 
dysfunctions that cause them. 

SOCIAL CHANGES 

At least as difficult as most of the phys- 
ical and mental changes that confront 
the aging are the social adjustments we 
all face as we grow older. Retirement 
from the workplace, limitations in mobil- 
ity in the larger world and separation 
from family and friends can place enor- 
mous psychological and emotional bur- 
dens on older people. 

Aging does not change the nature of a 
human being. Most elderly continue to 
be vital, alert, sensitive people whose 
capacities for emotion and social rela- 
tionships remain unchanged throughout 
their lives. Like younger people, they 
desire independence, control, choice, pri- 
vacy, intimacy. These needs can be diffi- 
cult to meet as the elderly require 
increasing levels of care; the fact that 
they often are not met probably accounts 
for the stubborn resistance an older indi- 
vidual may put up when faced with 
"going to the home." But these needs 
can be met if an architect refuses to let 
the clinical and technical demands of 
design for aging overwhelm his or her 
concern for the personal and social needs 
of the people for whom he or she is 
ultimately designing. 

With this concern in mind, Joe J. 
Jordan, FAIA, a gerontological planning 
consultant and architect, developed a 
comprehensive set of a dozen rules of 
thumb for designers of facilities for 
aging: 

• Increase opportunities for individual choice. 
One of the effects of aging is the dwind- 



ling number of options in many areas 
left open to the individual. The envi- 
ronment in a facility for aging can offset 
some of that effect by permitting the 
widest possible range of personal choices 
to the individual user, consistent with 
the needs of the group. 

• Minimize dependence and encourage indepen- 
dence. Especially for the elderly, the abil- 
ity to "do for oneself instills pride and 
enhances self-esteem. Design supports 
in a facility for aging should reinforce a 
sense of independence, unobtrusively 
and without providing more support 
than a prideful user would consider 
necessary. 

• Compensate for sensory and perceptive changes. 
An older person's inability to smell 
smoke, to hear a fire alarm or to see an 
obstacle in his or her path does not 
mean that person cannot absorb envir- 
onmental information. Such changes, 
however, do require allowances for 
longer reaction time and a sensitivity to 
the fact that other stimuli can compen- 
sate for sensory and perceptive losses. 

• Recognize the probability of decreases in phy- 
sical mobility. Walking, carrying, climb- 
ing, lifting, gripping, pushing and pull- 
ing are all motor functions that may be 
performed less adeptly and less force- 
fully by the elderly. 

• Improve orientation and comprehension. 
Because the physical ailments that often 
accompany aging can cause loss of 
memory and disorientation, an aging 
facility's spatial organization and circu- 
lation patterns should be simple and 
direct, and its materials and fixtures 
should be chosen with an eye to avoid- 
ing confusion in the environment. 

• Encourage social interaction. Old friends — 
and the making of new acquaintances in 
group settings — are particularly impor- 



I 11 



Social Changes 



tant to an older person whose social 
sphere shrinks when he or she retires, 
moves out of an old neighborhood or 
loses close friends to ill health or death. 
Stimulate participation. An older person 
whose self-esteem may be undercut by 
retirement from a life's work, a reduc- 
tion in income or just the reality of 
aging in a youth-oriented world can 
need not only a variety of opportunities 
to actively rebuild that self-esteem, but 
also some stimulation to participate and 
take advantage of those opportunities. 
Reduce conflict and distraction. A successful 
facility for aging may have several 
activities going on simultaneously — and 
part of its success will be from a design 
that prevents the activities from interfer- 
ing with one another and distracting 
users who can be easily distracted. 
Provide a safe environment. Because older 
people can be particularly sensitive to 
any threat of danger in the environ- 
ment, facilities for aging should incor- 
porate safety features that will be easy 
to use and comprehend, in daily life as 
well as in emergencies. 
Make activities and services accessible. A 
facility's location and design should ren- 
der it readily accessible to outside ser- 
vices, and easily accessible for the great- 
est possible number of older people in 
its community, regardless of their phys- 
ical condition. 

Improve aging's public image. Through its 
character and sheer esthetic quality, the 
architecture of a facility for aging can 
do a remarkable job of changing stereo- 
typical conceptions of the elderly and 
improving the community's attitude 
toward, interest in and concern for its 
aging population. 

Plan for growth and change. Facilities for 
aging constitute a relatively new build- 



ing type whose form is still evolving. 
That this evolution will continue well 
into the future is as certain as the fact 
that more and more Americans are 
growing older every day. 

Finally, two more rules of thumb are 
available to help architects retain their 
perspective on the social requirements 
of design for aging. First, engage in the 
greatest possible dialogue with those 
elderly who actually use facilities for 
aging today, and work hard to share an 
understanding of their needs and expe- 
riences. Second, remember that aging is 
a universal process, and that the desire 
to live an independent, satisfying life 
burns as intensely in us when we are 
aged as it does when we are young. As 
future candidates for admission to 
America's facilities for aging, we owe it 
to ourselves, as well as to our users, to 
design environments that help sustain 
that independence and attain that satis- 
faction for as long as possible. 



[I FACILITY TYPES 

The Continuum of Care 



II 13 



Like colors of the spectrum, the different 
types of environments used by the aging 
seem infinite in number, and they are 
often so closely overlapped that charac- 
terizing them distinctly can be next to 
impossible. In the subset of facilities 
designed specifically for aging, distinc- 
tions can be just as hard to come by; the 
range of available living environments, 
social environments and settings for the 
delivery of personal, social and health 
care services is broad. Such complexity 
characterizes the matrix that is most 
commonly used to differentiate facility 
types designed for aging. 

The specific sets of services provided in 
particular facility types are drawn from 
the wide variety of different services 
needed for older people, a variety that 
ranges from simple information and 
referral services to complex health care 
services. To describe every combination 
of service options within this range 
would be virtually impossible, as would 
any attempt to identify all the permuta- 
tions and combinations of facility types 
incorporating such service packages that 
imaginative architects and clients have 
invented. Instead, just as we isolate pri- 
mary points along the color spectrum, 
we can isolate the most common facility 
types being developed today for older 
users, and treat them as landmarks 
along the spectrum of facilities designed 
for older people. 



The five landmark facility types con- 
sidered here (in ascending order of 
breadth of services provided) — 

• elderly housing 

• senior/community centers 

• residential care facilities 

• nursing homes 

• continuing care retirement communities 

— range across most of the facility-type 
spectrum and involve most of the pro- 
grammatic and design issues with which 
an architect designing for older users 
must contend. 

Each of these five landmark facility types 
is examined here in terms of its scale 
and scope, its principal form-generating 
elements, its special features, and the 
details and variations unique to it. Each 
description is illustrated with building 
diagrams that set out desirable relation- 
ships between spaces. Each is also accom- 
panied by an adjacency matrix that fur- 
ther spells out specific functional area 
relationships. 

Finally, each major facility type treated 
here is accompanied by a programming 
and design checklist that identifies all of 
the important design elements an archi- 
tect engaged in design for aging must 
consider. The checklists are designed to 
be used from the outset of project pro- 
gramming and design, and to aid the 
architect in three distinct ways: 

• As a comprehensive starting point that 
will, at the programming stage, enable 



14 II 



Continuum of Care 



both architect and client to identify and 
put in priority order the major concerns 
of the facility at hand and the needs of 
its users. The involvement of the client 
(and perhaps of the users) can be vital 
at this stage, because so many of the 
facility types emerging today are shaped 
by clients' and users' reactions to older 
facility models. The kind of dialogue 
and review of key spaces, services, rela- 
tionships and other issues that these 
checklists enable may prove provoca- 
tive, suggestive and helpful to all 
involved in the design process. 

• As a point of access to design guidelines for 
the architect, to be consulted as pro- 
gramming and design advance. Check- 
list items that are aging- specific are 
keyed to entries in Part III: Glossary, 
where the architect will find the specific 
design and detailing information needed 
to translate the checklists' programming 
and design issues into functional design 
elements. 

• As a quick reference to ensure that all 
programmatic and design concerns have 
been addressed in the design process. 

The checklists will not, however, serve as 
points of access to all of the information 
required to program, plan, design and 
detail a facility for aging — or even for 
one of the landmark facility types dir- 
ectly covered here. To achieve that end, 
the architect also must explore the liter- 
ature referenced in the annotated bibli- 
ography, become familiar with the var- 
ious aging organizations that will be 
involved in the project, and use the 
standard architectural practice references 
pertinent to the task at hand. 



The architect should contact the local 
Area Agency on Aging to determine 
what groups and aging organizations 
may have involvment in the particular 
project at hand. The AAAs are responsi- 
ble for coordinating local programs, 
including social programs (for example, 
senior centers), food services, elderly 
housing, and information and referral 
services. Additionally — because so many 
elderly facility types are regulated by 
state or municipal health, housing or 
social service agencies, or by financing 
and/or reimbursement agencies — the 
architect must become familiar with all 
relevant codes, standards and require- 
ments of the agencies having jurisdic- 
tion, and then derive a specific design 
code for the project that reconciles often 
conflicting and overlapping requirements. 
The architect may also be required to 
persuade agencies that rigidly adhere to 
old concepts that new facility types may 
be needed, that traditional dividing lines 
between "housing," "health" and 
"social service" facilities for the elderly 
have become blurred. All of these steps 
may be necessary to properly advise the 
client and, ultimately, serve the user. 

CONTINUUM OF CARE 

Facilities designed for use by older peo- 
ple can usually be characterized by their 
specific supportive, living and/or social 
environments, and by the physical set- 
tings they provide for the delivery of 
personal, social and health care services. 
Not all personal, social and health care 
services must be provided in a specific 
facility, however. The services that older 
people need can range in level from very 
low — say, the provision of maintenance 



II 15 



Continuum of Care 



on an other wise fully independent per- 
son's private home — to the high level of 
service that might be provided in a nurs- 
ing home. Services commonly provided 
for older people include, for example: 

information and referral 

physical security 

home maintenance and repair 

leisure activities, including recreation, 
the arts, educational and social activities 

transportation 

counseling (personal, social, financial, 
insurance, legal, religious) 

companionship 

residential services (housekeeping, laun- 
dry, food shopping, meal preparation) 

housing assistance 

reimbursement assistance 

central food service 

assistance with medication 

adult day care 

personal care (assistance with such 
activities of daily living as bathing, 
toileting, grooming, dressing and eat- 
ing) 

• custodial care (24-hour supervision) 

• therapy (rehabilitation, physical, occu- 
pational, mental health) 

• health care (home, ambulatory or out- 
patient, long-term chronic, acute, 
emergency) 

This list of services — some common in 
facilities designed for older people and 
some not — begins with the lowest, least 
intensive levels for a reason: The least 
service is generally deemed best, because 
it maintains the greatest level of inde- 
pendence for the aging user at the lowest 
cost. 



Unfortunately, most older individuals do 
not fit neatly into this order of services; 
few require a specific maximum level of 
service plus all of the services below that 
level. Most older people need a little of 
this (low-level) service and a little of that 
(high-level) service on one day, and a 
different mix of services on the next day. 
The challenge of caring for the aging is 
to meet these diverse and changing 
needs through a network of different ser- 
vice providers, which together constitute 
a "continuum of care." 

Certain care services are obviously best 
provided in a specific facility. The high 
cost of services usually prevents us from 
providing each aging person with an 
individually tailored environment. 
Therefore, to contain costs, heighten effi- 
ciency and increase the quality of care 
(as well as the quality of life), groups of 
older people with similar needs and 
requirements are accommodated in a 
facility type that offers a relatively fixed 
range of services. Thus, the great variety 
of individual service needs is met in a 
relatively limited spectrum of facilities 
designed for aging. 

Key facility types in this spectrum 
appear in the following figure, again 
listed in an order that ascends from least- 
to most-intensive service levels. The 
landmark facility types (in bold face in 
the figure) are those covered in greater 
depth on the following pages. Require- 
ments for facility types enclosed by 
parentheses closely resemble require- 
ments for the preceding unbracketed 
facility type. 



16 II 



Continuum of Care 



SPECTRUM OF FACILITY TYPES FOR AGING 
Level of Dependence Facility Type 



Very Low 



Single-Family Housing/Apartments 
Accessory Apartments (see Page 62) 
Granny Flats (see Page 95) 
• (Echo Housing) 



Moderate-Low 



Retirement Mobile Home Parks 

Elderly Housing (Multiunit) 

• (Retirement Subdivisions) 

• (Retirement Villages) 

• (Retirement Towns) (see Page 122) 
Group Homes (see Page 95) 

• (Small-Group Cooperative Housing) 

• (Shared Housing) 
Senior Centers 

• (Community Centers) 



Moderate 



Congregate Housing (see Page 81) 

• (Retirement Hotels) 

Adult Day Care Centers (see Page 64) 
Respite Care Centers (see Page 122) 
Residential Care Facilities 

• (Domiciliary Care Facilities) 

• (Board and Care Facilities) 

• (Personal Care Homes) 

• (Adult Foster Homes) 

• (Homes for the Aged) 

• (Rest Homes) 

• (Health-Related Facilities) 
Hospices (see Page 99) 



Moderate-High 



Nursing Homes 

• (Convalescent Homes) 

• (Health-Related Facilities) 

• (Intermediate Care Facilities) 

• (Skilled-Nursing Facilities) 

• Continuing Care Retirement Community 

• (Multilevel Facilities) 



High 



Rehabilitation Hospitals 
Acute-Care Hospitals 



II 17 



ELDERLY HOUSING 



MAJOR BUILDING TYPES 

In the discussions that follow for the five 
landmark facility types, items identified 
in bold face type appear as entries in 
Part III: A Design for Aging Glossary. 

ELDERLY HOUSING 

The term "elderly housing" refers to all 
types of independent and semi-indepen- 
dent housing facilities in which elderly 
residents are generally able to care for 
themselves without supervision and 
extensive medical attention. The range 
of elderly housing extends from resident- 
owned single-family houses to multiunit 
housing projects and congregate 
housing. 

Major Spaces. The principal form gen- 
erators in elderly housing are the dwell- 
ing units, each of which generally 
includes such familiar components as an 
entry area, living/dining room, 
kitchen, bathroom, bedroom, storage 
space and balcony, and each of which 
should be adaptable for use by handi- 
capped persons. 

Variations in this typical makeup can be 
dictated by a number of factors, includ- 
ing location, site, financing and the eco- 
nomics of rental mix (the mix of effi- 
ciency, studio and one- or two-bedroom 
units). Client involvement in program- 
ming is essential here, because the 
client's criteria are the most pertinent. 



Programming and Design Considera- 
tions. The programming and design 
procedure considers the human needs 
and values of the elderly, and must start 
with a definition of the type and scope of 
development intended. The following 
considerations must be addressed to 
establish that definition: 

• Consider how many dwelling units will 
be provided, and of what types and 
floor areas. 

• Consider what type, number and mag- 
nitude of common service facilities (such 
as central dining spaces, activity rooms 
and lounges) will be provided. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
(such as house keeping, storage, main- 
tenance, security and management) will 
be provided. 

• Consider the location of the site, and its 
physical features, size, contours, con- 
straints. 

• Consider how much parking will be 
required. 

Development Size and Dwelling-Unit 
Mix. Experience suggests the following 
general rules: 

• The minimum sizes of housing develop- 
ments solely for the elderly vary accord- 
ing to financing, program and location. 
Developments that are subsidized by 
public and/or private agencies may con- 
tain as few as six or 10 units targeted to 



18 II 



Elderly Housing 



specific community needs. Market 
developments for the elderly generally 
should not be smaller than 90 to 100 
dwelling units, to economically justify 
such programmed services as security, 
activities, transportation, counseling, 
residential services and central food ser- 
vices. Rural developments usually are 
smaller (10 to 45 units) in recognition of 
lower demand and lower density life- 
styles. 

• A recommended maximum size of 200 
to 350 dwelling units is based on the 
assumption that high concentrations of 
elderly people may tend to encourage 
isolation from the community and could 
possibly cause abnormal neighborhood 
development. 

• Each development of elderly housing 
should offer a range of dwelling-unit 
types and sizes to accommodate a wide 
range of housing needs and life-styles. 
The specific dwelling-unit mix for each 
development of elderly housing must be 
determined with the client. 

Density. The determination of site den- 
sity should be considered as a process 
rather than as a set of preconceived den- 
sity requirements. Both the site and the 
development program should be consid- 
ered in the final determination of opti- 
mal site density. The number of units 
proposed, the size of the proposed site, 
the amount of common area, the park- 
ing required and the gross open space to 
be provided should be included. In many 
instances, livability is equated with den- 
sity, resulting in the establishment of a 
prescribed limit for the maximum num- 
ber of dwelling units per acre that will 
be permitted. Maximum density-ratios 
can limit creative approaches to the 
development of housing environments. 



Other Factors. These special factors 
affecting the elderly should also be con- 
sidered: 

• Elderly people are less mobile than peo- 
ple in younger age groups. Therefore, 
the housing dwelling unit should be 
conceived of as a home, and not as 
transient housing. 

• The elderly desire a choice in living 
situations, within a given community. 
Therefore, a variety of dwelling unit 
sizes and floor plans should be 
provided. 

• Lack of mobility may limit an elderly 
resident's ability to reach community 
recreation and social service facilities. 
Providing the basic services and facil- 
ities within easy walking distance (or 
within immediate living environs) 
should be considered. Otherwise, the 
developer may have to offer transporta- 
tion services to facilitate occupancy by 
elderly residents. 

• The elderly desire a sense of autonomy, 
and they need an environment that 
extends and enhances the duration of 
independent living. Therefore, the 
architect should provide the special 
design features and details recom- 
mended under specific rooms and 
spaces in Part III: A Design for Aging 
Glossary. 



II 19 



Elderly Housing 



• The elderly require as much floor area 
for their activities as younger people 
require for the same activities — or 
more, to accommodate life-time collec- 
tions of furniture, furnishings and mem- 
orabilia. They also may require special 
design adaptations to accommodate 
possible physical limitations, such as 
support for potential future installations 
of lower counter tops, storage units and 
grab bars (see adaptability). Space for 
potential future wheelchair access should 
be provided in all areas of the dwelling 
unit (see ANSI Al 17.1). 



• Except for a greater amount of time 
spent in the dwelling unit, activity pat- 
terns for elderly people are much the 
same as those for younger people, dif- 
fering only in the way older people may 
wish to or be able to perform certain 
activities. This consideration may affect 
space dimensions, materials, finishes, 
colors, lighting, placement of windows 
and doors, architectural hardware, 
selection of equipment and fixtures (see 
control), and sign systems. 



20 II 



Elderly Housing 



ENTRANCE 
LEVEL 




II 21 



A Corridor — offset to reduce visual 
length and to provide vista ter- 
mination. 

B Lounge — adjacent to activity and cir- 
culation nodes; good for meetings or 
waiting for laundry. 

C Overhang — helps to reduce sky glare 
if it is kept to 6 feet or 7 feet above 
the floor; potential glare problems 
require opaque curtains or external 
shading. 

D Entrance Alcoves — relieve an other- 
wise "door- after-door" look to the 
corridor; mark transition and help to 
establish a hierarchy of spaces. 

E Dwelling Unit Entries — offset to 
increase sense of privacy. 

F Balconies — provide access to private 
outdoor spaces. 

G Screen — desirable between private 
balconies and to provide more of a 
sense of security. 

H Dimensions & Door Swings — per- 
mits wheelchair access. 

I Bathroom Door — opens out for emer- 
gency access and to provide more 
maneuvering space in the bathroom. 

J Emergency Call Device 

K Windows & Interior Corners — 
located in increase variations in fur- 
nishability. 

L Storage — substantial amounts of 
storage are required for accumulated 
personal possessions. 



10 Kitchen 

11 Mechanical 

12 Trash 



Efficiency Unit 

1 One Bedroom Unit 

2 Two Bedroom Unit 

3 Lounge 

4 Dining 

5 Reception 

6 Administration 

7 Laundry 

8 Residents' Storage 

9 M/F Toilet 



Credit: 

Noakes and Associates, Bethesda, 
Maryland 



Elderly Housing 




J&Cn 



€B J3 




ONE BEDROOM UNIT 




i; 

UNIT 




EFFICIENCY 



22 II 



Elderly Housing Adjacency Matrix 



SITE 



ACTIVITY AREAS 



GARDENS 



SEATING 



PARKING 



SITE ENTRIES 



BUILDING ACCESS 



LOBBY 



LOUNGE 



MAIL & PACKAGE 



SIGNAGE/DIRECTORY 



PUBLIC TOILETS 



PUBLIC TELEPHONES 



ADMINISTRATION 



RECEPTION 



OFFICES 



SOCIAL SERVICES 



SERVICE 



HOUSEKEEPING 



MAINTENANCE 



STORAGE, LONG-TERM 



MECHANICAL SPACES 



SERVICE ENTRY 



STAFF ENTRY 



STAFF LOCKERS 



CENTRAL FOOD SERVICE 



KITCHEN, COMMERCIAL 



DINING ROOM 



STORAGE. FOOD 



SNACK BARS 



ACTIVITY AREAS 



LOUNGES 



ASSEMBLY/MEETING ROOM 



TELEVISION VIEWING 



GAME ROOM 



ARTS & CRAFTS 



EXERCISE 



RESIDENT CORRIDORS 



LAUNDRY ROOM 



BALCONIES 



SUNROOMS 



RESIDENTIAL SERVICES 



SHOPS 



BANKING 



DWELLING UNITS 



ENTRANCE/FOYER 



LIVING ROOM 



PATIO/BALCONY 



KITCHEN 



STORAGE 



UTILITIES 



BATHROOMS 



BEDROOMS 



LAUNDRY 




II 23 



Elderly Housing Checklist 



Elderly Housing Adjacency Matrix 
and Checklist. The adjacency matrix 
and checklist that follow are more com- 
prehensive than may be required for 
most projects; they reflect an effort to 
include all possible elements that might 
figure in the programming process. 

Similarly, the adjacency matrix shown is 
the matrix for congregate housing, used 
here to present one of the most elaborate 
combinations of relationships encoun- 
tered in current elderly-housing facility 
types. The architect should modify this 
matrix to conform with the specific 
requirements of the client and the partic- 
ular facility type being planned. 

ELDERLY HOUSING: CHECKLIST 

• Items on the checklist which are in bold 
type and have a page number are 
keyed to Main Entries in the Glossary. 

• Items which are in normal type and 
have a page number are discussed in 
the Glossary on the specified page. 

• Items which are in normal type and 
have no page number are not discussed 
in the Glossary, and the architect is 
expected to use other sources. 

Site Analysis (see Page 128) 
Public Transportation 
Location (see Page 128) 
Neighborhood (see Page 128) 
Security (see Page 125) 
Orientation 
Selection 

Topography (see Page 129) 
Zoning (see Page 129) 
Market (Needs) Analysis 



Site Development (see Page 130) 
Outdoor Spaces (see Page 132) 
Circulation 

• Emergency (police, fire, 
ambulance) 

• Pedestrian 

• Residents 

• Delivery Service, Garbage 
Collection, Maintenance, 
Landscaping and Grounds- 
keeping Vehicles, Snow 
Removal and/or Storage 

• Staff 

• Vehicular 

• Visitors 
Landscaping (see Page 135) 

• Gardens 

Lighting (see Page 104) 
Outdoor Recreation 

• Checkers/Chess 

• Swimming Pool 

• Tennis 

• Badminton 

• Putting Green/Golf Course 

• Croquet 

• Horseshoes 

• Boccie/Lawn Bowling 
Parking (see Page 135) 

• Barrier- Free (see Page 135) 

• Residents (see Page 136) 

• Staff 

• Visitors 

Patios (see Page 133) 
Seating (see Page 123) 
Security (see Page 125) 
Shelter 

Sign Systems (see Page 126) 
Solar Orientation (see Page 136) 
Water Supply and Sewage 
Systems 



24 II 



Elderly Housing Checklist 



Entries, Building (see Page 89) 
Barrier-Free (see Page 71) 
Control 

Emergency Exit (see Page 93) 
Main (see Page 89) 
Secondary 

Service (see Page 92) 
Visitors/Staff/Residents 
Lounge (see Page 106) 

Lobby/Reception Areas (see Page 106) 
Control 

Directory (see Page 127) 
Front Desk 

Seating (see Page 123) 
Mail and Package Delivery 
(see Page 109) 

Toilet Rooms, Public (see Page 142) 
Sign Systems (see Page 126) 
Storage 
Telephones (see Page 79) 

Office and Administrative Space 

(see Page 114) 

Administrative Services 

Communication Systems 

(see Page 78) 

Control/Security 

Social Services (see Page 138) 

Housekeeping (see Page 99) 

Janitors (see Page 99) 

Linen 

Maintenance 

Receiving 

Storage, Long-Term 

(see Page 140) 

Trash (see Page 99) 

Vertical Transportation 
Elevators (see Page 88) 
Elevator Lobbies 
Ramps (see Page 117) 
Stairs (see Page 139) 



Central Food Service 

Dining Areas (see Page 85) 

Employee Lockers 

Employee Rest Rooms 

Kitchen (see Page 100) 

Office — Dietitian 

Service (Receiving) 

Snack Bars (see Page 138) 

Storage 

Trash 

Vending (see Page 138) 

Activity Areas (see Page 63) 
Arts and Crafts (see Page 67) 
Assembly Areas (see Page 69) 
Balconies, Common 
(see Page 69) 
Chapel (see Page 147) 
Corridors (see Page 83) - 
Exercise Areas, Health Club, 
Fitness Facilities (see Page 92) 
Game Rooms 
Lounges (see Page 106) 
Multipurpose (see Page 110) 
Performing Arts Areas 
(see Page 116) 
Reading/Library Areas 
(see Page 118) 
Sun Rooms (see Page 140) 
Television Viewing Areas 
(see Page 141) 
Swimming Pool 

Residential Services (see Page 119) 
Banking 
Beauty/Barber 
Consultation Room 
(see Page 82) 

Housekeeping (see Page 99) 
Laundry Facilities 
(see Page 103) 

• Accessories (see Page 103) 

• Adaptability 

• Auxiliary Heat 



II 25 



Elderly Housing Checklist 



• Storage/Linen 
Nurse/First Aid 
Shops (see Page 126) 

• Gift 

• Grocery 

Dwelling Units 

Bathrooms (see Page 72) 

• Accessories (see Page 75) 

• Adaptability (see Page 72) 

• Auxiliary Heat 

• Fixtures/Controls 
(see Page 73) 

• Storage/Linen 
Bedrooms (see Page 75) 

• Beds (see Page 76) 

• Furnishability (see Page 95) 

• Storage/Closets 

• Storage/Furnishings 

• Television 

• Windows/Views (see Page 75) 
Entries, Dwelling Unit 

(see Page 89) 

• Door/Signage/Identifi- 
cation/Hardware 

(see Page 91) 

• Storage (see Page 92) 
Kitchens (see Page 100) 

• Adaptability 

• Dining 

• Equipment (see Page 100) 

• Fixtures (see Page 102) 

• Storage (see Page 103) 
Laundry 

Living/Dining Room 
(see Page 105) 

• Furnishability (see Page 105) 

• Furniture (see Page 106) 

• Television (see Page 105) 

• Windows/ Views (see Page 106) 
Balcony, Private (see Page 69) 

• Seating (see Page 70) 



• Outdoor Access (see Page 70) 
Storage (see Page 140) 

• Walk-in 

• Bulk 
Utilities 
Windows/Views (see Page 145) 

Mechanical Facilities 

Gross Area Requirements 
Gross/Net Area Requirements 
Airconditioning Requirements 
Electrical Requirements 
Fire-Protection Requirements 
Plumbing Requirements 
Security, Communication 
Systems and Alarms 
Patios and Roof Terraces 



26 II 



SENIOR/COMMUNITY CENTERS 



Senior centers are primarily neighbor- 
hood facilities, and thus should be 
designed to reflect the characteristics of a 
neighborhood's specific population. The 
ethnic background, social class, econo- 
mic status, physical condition and age of 
a center's participants all contribute to 
its characteristics, and largely determine 
the activities carried out in it. Many 
senior centers are located in donated 
facilities. As a rule, these buildings — 
church halls; YMCAs; municipal build- 
ings; storefronts, and surplus public 
buildings, such as post offices, schools, 
historic houses and libraries — have been 
only slightly and insufficiently renovated 
to provide for the special needs of elderly 
users. 

Community centers are common compo- 
nents in Continuing Care Retirement 
Communities (CCRCs), and in many 
other types of retirement housing. They 
serve many of the same functions as 
senior centers, and provide residential 
services such as banking and pharmacy. 
In a CCRC, the community center often 
is the focal point of the community, 
serving as the main entrance to the total 
development and as the site of most 
group and administrative activities. 

Senior/community centers are social, 
activity and communication centers for 
elderly people who enjoy coming 
together for common events and ser- 
vices, and who share similar interests, 
needs and aspirations. These centers are 
places in which older people can meet 
others of their own age, learn new skills, 
participate in cultural and recreational 
activities and receive counseling, health 
care and meals. 



A community center is typically spon- 
sored by the CCRC of which it is a 
part, but sponsorship for senior centers 
is equally divided between public and 
private sources. Most senior centers are 
small (with fewer than 50 members) and 
have a board of directors and a paid 
professional staff. The number of senior 
centers has grown to over 5,000 nation- 
wide since their inception in 1943. 

Major Spaces. The principal form-gen- 
erating spaces in senior/community cen- 
ters are highly variable — a result of 
highly variable programs, groups and 
activity schedules. Services (nutritional, 
health, social and educational), activities 
(recreational and social-cultural) and 
scheduled group sizes will determine the 
type and size of space to be designed. 

Spaces often programmed for senior and 
community centers include entries, 
lobby/reception areas, lounges, televi- 
sion viewing areas, libraries, class- 
rooms, activity areas, common dining 
areas, snack bars, outdoor recreation 
areas, individual service areas (for coun- 
seling and/or clinical services), meet- 
ing/assembly areas suitable for visual 
and performing arts, and music rehear- 
sal and listening areas. Also included fre- 
quendy are support areas such as com- 
mercial kitchens and administrative 
offices. 

Programming and Design Considera- 
tions. The programming and design 
procedure considers the human needs 
and values of the elderly, and must start 
with a definition of the type and scope of 
development intended. The following 



II 27 



Senior/Community Centers 



A Lounge — adjacent to activity and 

circulation. 
B Reception Area — with visual control 

of major spaces. 
C Dividers — can subdivide space into 

large and small areas with separate 

access. 
D Multipurpose Room — space useable 

for performing arts, chorus. 
E Storage Room — for multipurpose 

spaces' tables and chairs. 
F Restrooms — accessible to wheelchairs 



1 Lounge 

2 Arts & Crafts Area 

3 Multipurpose Room 

4 Reception 

5 Administration/Office 

6 M/F Toilet 

7 Kitchen 

8 Storage 

Credit: 

Joe J. Jordan, FAIA, Philadelphia 



SENIOR CENTER 




28 II 



Senior/Community Centers 



considerations must be addressed to 
establish that definition: 

• Consider what types of services and 
activities will be provided, for what 
group sizes and for what times of the 
day. 

• Consider what type, number and mag- 
nitude of service facilities (such as cen- 
tral dining spaces, activity rooms and 
lounges) will be provided. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
(such as maintenance, storage, security 
and management) will be provided. 

• Consider the location of the site, and its 
physical features, size, contours and 
constraints. If applicable, consider the 
physical characteristics of the existing 
building to be adapted to senior/com- 
munity center use. 

• Consider how much parking will be 
required. 

Development Size. Experience suggests 
the following general rules: 

• Developments vary in size to accommo- 
date 25 to 500 center members. Smaller 
developments typically are restricted to 
minor conversions of existing space. 
Larger senior/community centers often 
are freestanding, purpose-built facilities 
for 350 to 500 members. Senior/Com- 
munity centers serving CCRCs are gen- 
erally planned to serve on-site CCRC 
residents as well as participants in any 
outreach programs conducted in the 
center to strengthen ties with the 
broader community. 

• Each senior/community center should 
offer a range (types and sizes) of service 
space and activity space, to accommo- 
date a multitude of services and activi- 
ties. The specific functional space mix 



of each development must be deter- 
mined with the client. 

Other Factors. These special factors 
affecting the elderly must also be con- 
sidered: 

Image and ease of access are significant 
issues in senior/community center 
design. Generally, a strong visual image 
that announces the center's presence is 
desirable. Integration with public trans- 
portation and both pedestrian and auto- 
mobile access is also important. 
Assembly areas should be located near 
lobby or lounge areas. Where fixed 
seating is provided, aisles should be five 
feet wide for the movement of wheel- 
chairs and walkers, and sufficient 
wheelchair spaces should be provided. 
Spacing between rows (back-to-back) 
should be 40 inches. Seats should be 22 
to 30 inches wide and upholstered, but 
firm (see seating). 

A good distortion-free public address 
system is important. If possible, head- 
sets should be provided for a few seats 
near the front (to allow lipreading for 
those with hearing loss), as should a 
projection room to eliminate back- 
ground noise from the projector, which 
can be particularly bothersome for the 
elderly. 

The provision of separate meeting 
spaces should be considered, especially 
in larger facilities. Small centers with 
lower daily attendance often use other 
rooms — lounges, dining areas or 
multipurpose rooms — rather than 
separate meeting spaces for assembly. 
Elderly people are less mobile than 
younger people, so the modes of trans- 
portation that center members will use, 
as well as passenger-loading platforms, 



II 29 



Senior Center Adjacency Matrix 



SITE 



ACTIVITY AREAS 



SEATING 



PARKING 



SITE ENTRIES 



BUILDING ACCESS 



LOBBY 



LOUNGE 



SIGNAGE/DIRECTORY 



PUBLIC TOILETS 



PUBLIC TELEPHONES 



ADMINISTRATION 



RECEPTION 



OFFICES 



SOCIAL SERVICES 



SERVICES 



HOUSEKEEPING 



MAINTENANCE 



STAFF ENTRANCE 



STAFF LOCKERS 



CENTRAL FOOD SERVICE 



KITCHEN, COMMERCIAL 



DINING ROOM 



STORAGE, FOOD 



SNACK BARS 



ACTIVITY AREAS 



LOUNGES 



ASSEMBLY/MEETING ROOM 



TELEVISION VIEWING 



GAME ROOMS 



ARTS & CRAFTS 



EXERCISE 



BALCONIES 



SUN ROOMS 



CARE SERVICES 



CONSULTATION ROOM 



NURSE'S FIRST AID 




30 II 



Senior Center Checklist 



parking and pedestrian access, must be 
carefully considered. 
• The elderly desire a sense of autonomy, 
and they need an environment that 
extends and enhances the duration of 
independent activity. Therefore, provide 
the special design features and details 
recommended under specific rooms and 
spaces in Part III: A Design for Aging 
Glossary. 

SENIOR/COMMUNITY CENTER 
CHECKLIST 

• Items on the checklist which are in bold 
type and have a page number are keyed 
to Main Entries in the Glossary. 

• Items which are in normal type and 
have a page number are discussed in 
the Glossary on the specified page. 

• Items which are in normal type and 
have no page number are not discussed 
in the Glossary, and the architect is 
expected to use other sources. 

Site Analysis (see Page 128) 
Public Transportation 
Location (see Page 128) 
Neighborhood (see Page 128) 
Security (see Page 125) 
Orientation 
Selection 

Topography (see Page 129) 
Zoning (see Page 129) 

Site Development (see Page 130) 
Outdoor Spaces (see Page 132) 
Circulation 

• Emergency (police, fire, ambulance) 

• Pedestrian 

• Residents 

• Delivery Service, Garbage Collec- 
tion, Maintenance, Landscaping 
and Groundskeeping Vehicles, 
Snow Removal and/or Storage 



• Staff 

• Vehicular 

• Visitors 
Landscaping (see Page 135) 

• Gardens 

Lighting (see Page 104) 
Outdoor Recreation 

• Checkers/Chess 

• Swimming Pool 

• Tennis 

• Badminton 

• Putting Green 

• Croquet 

• Horseshoes 

• Boccie/Lawn Bowling 
Parking (see Page 135) 

• Barrier-Free (see Page 135) 

• Residents (see Page 136) 

• Staff 

• Visitors 

Patios (see Page 133) 

Seating (see Page 123) 

Security (see Page 125) 

Shelter 

Sign Systems (see Page 126) 

Solar Orientation (see Page 136) 

Water Supply and Sewage Systems 

Entries, Building (see Page 89) 
Barrier-Free (see Page 71) 
Control 

Emergency Exit (see Page 93) 
Main (see Page 89) 
Secondary 

Service (see Page 92) 
Visitors/Staff/Residents 
Lounge (see Page 106) 

Lobby /Reception Areas (see Page 106) 
Coat Room/Storage/Lockers Control 
Directory (see Page 127) 
Front Desk 

Seating (see Page 123) 
Mail and Package Delivery 
(see Page 109) 



II 31 



Senior Center Checklist 



Toilet Rooms, Public (see Page 142) 

Sign Systems (see Page 126) 

Storage 

Telephones (see Page 79) 

Office and Administrative Space 

(see Page 114) 

Administrative Services 

Communication Systems 

(see Page 78) 

Control/Security 

Social Services (see Page 138) 

Housekeeping (see Page 99) 
Janitors (see Page 99) 
Linen 

Maintenance 
Receiving 

Storage, Long-Term (see Page 140) 
Trash (see Page 99) 

Vertical Transportation 
Elevators (see Page 88) 
Elevator Lobbies 
Ramps (see Page 117) 
Stairs (see Page 139) 

Central Food Service 

Dining Areas (see Page 85) 

Employee Lockers 

Employee Rest Rooms 

Kitchen (see Page 100) 

Office — Dietitian 

Service (Receiving) 

Snack Bars (see Page 138) 

Storage 

Trash 

Vending (see Page 138) 

Activity Areas (see Page 63) 
Arts and Crafts (see Page 67) 
Assembly Areas (see Page 69) 
Balconies, Common (see Page 69) 
Chapel (see Page 147) 
Corridors (see Page 83) 



Exercise Areas, Health Club, Fitness 
Facilities (see Page 92) 
Game Rooms 
Lounges (see Page 106) 
Multipurpose (see Page 110) 
Performing Arts Areas (see Page 116) 
Reading/Library Areas (see Page 118) 
Sun Rooms (see Page 140) 
Swimming Pool 
Television Viewing Areas 
(see Page 141) 

Existing Building Evaluation for 
Renovation 

Accessibility 

Adaptability of Spaces for: 

• Acoustics 

• Corridors 

• Doors 

• Elevators 

• Finishes 

• Flexibility 

• Furniture and Furnishings 

• Lighting 

• Stairs 

• Windows 

Care Services (see Page 64, 112) 

Consultation Room(s) (see Page 82) 
Examination Room(s) (see Page 92) 
Nurse/First Aid 
Therapy Room(s) (see Page 141) 

• Physical (see Page 142) 

• Occupational (see Page 142) 

Mechanical Facilities 

Gross Area Requirements 
Gross/Net Area Requirements 
Airconditioning Requirements 
Electrical Requirements 
Fire-Protection Requirements 
Plumbing Requirements 
Security, Communication Systems 
and Alarms 



32 II 



RESIDENTIAL CARE FACILITIES 



Residential care facilities provide a level 
of care for older people who can no 
longer live independently in elderly 
housing, but who do not need the level 
of medical services provided by nursing 
homes. Residential care residents are 
often characterized by a variety of dis- 
abling diseases (such as joint and cardio- 
vascular diseases) and by various degrees 
of sensory and cognitive impairment. 
They frequently require assistance with 
bathing, laundry, cleaning, money 
management, shopping and medication. 

Residential care facilities are similar to 
personal care homes, domiciliary care 
facilities and board and care homes; a 
wide range of services is typically 
provided in a residential setting that 
includes private or semiprivate "living 
units," a central meal service, help with 
personal needs, assistance with house- 
keeping chores, the administration of 
medication and supervision in the basic 
activities of daily living, such as bathing, 
dressing, grooming and personal 
hygiene. Medical and nursing care typic- 
ally are not provided. Residential care 
facilities are usually licensed by state 
departments of social services; whereas, 
nursing homes are generally licensed by 
state departments of health and hygiene. 

Although variations of the residential 
care facility concept have long been in 
operation (many were established in the 
form of domiciliaries to care for veterans 
after the Civil War), their development 
for use by older people has been wide- 
spread only in recent years. This devel- 
opment has been spurred by efforts to 
contain the costs of health care that 
restrict the development of new nursing 
home beds, which has created a new 



market opportunity offering lower levels 
of care for older people who cannot 
maintain themselves in elderly housing 
without special personal care. To reach 
this market, many continuing care 
retirement communities also provide res- 
idential care as a component of their 



services. 



Major Spaces. Residential care facilities 
generally provide private or semiprivate 
living units, each with bathroom, but 
without private kitchen, in a building 
that is residential (as opposed to institu- 
tional) in character. The living units are 
more like hotel rooms than apartments, 
and thus typically combine entry area, 
living room, bedroom and storage in 
one room. Many of the functions 
required of the nursing home resident's 
room also must be served by the resi- 
dential care private room. Living units 
and bathrooms should be accessible (see 
ANSI A117.1) and include the special 
design features discussed under the spe- 
cific rooms and spaces listed above in 
bold face type. 

Residential care facilities generally are 
divided into sections, with each section 
containing 30 to 40 living units, a 
lounge, activity areas, outdoor access 
through a balcony or patio, automatic 
laundry facilities, a kitchenette/snack/ 
dining area, a personal care service area 
that includes a work area for support 
staff, and a central bathing room. 

Central facilities that are typically avail- 
able to all residents include the central 
dining room(s), a medication/screen- 
ing/treatment room(s), a beauty/barber 
shop, a library, a gift shop, craft rooms, 
a small formal lounge, an all-purpose 



II 33 



Residential Care Facilities 



assembly area, a performing arts area, 
a small worship area, and other spaces 
as defined by the client. Private central 
spaces generally include offices, central 
laundry facilities, a commercial 
kitchen, and building and grounds main- 
tenance shop. 

Programming and Design Considera- 
tions. The programming and design 
process considers the human needs and 
values of the elderly, and must start with 
a definition of the type and scope of 
development intended. The following 
considerations must be addressed to 
establish that definition: 

• Consider how many living units, what 
range of floor areas, and what types of 
units will be provided. 

• Consider what type, number and mag- 
nitude of common service facilities (such 
as central dining, activity rooms and 
lounges) will be provided. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
(such as housekeeping, maintenance, 
security and management) will be pro- 
vided. 

• Consider the location of the site, and its 
physical features, size, contours and 
constraints. 

• Consider how much parking will be 
required. 

Development Size and Dwelling Unit 

Mix. Experience suggests the following 
general rules: 

• The minimum size of residential care 
developments for the elderly varies 
according to financing, program, and 
location. Residential care generally is 
developed in multiples of 30 to 40 living 
units. A development of fewer than 100 
units is typically part of a larger devel- 



opment, such as a CCRC, to econom- 
ically justify the needed management, 
personal care, meal and social services 
and facilities. 

• A recommended maximum size of 200 
living units is based on the assumption 
that high concentrations of elderly peo- 
ple may tend to encourage their isola- 
tion from the community and could 
cause abnormal neighborhood develop- 
ment. 

• Each development of residential care 
facilities should offer a range of living- 
unit types and sizes to accommodate a 
wide range of personal care needs and 
life-styles. The specific living-unit mix 
of each development must be deter- 
mined with the client. 

Other Factors. These special factors 
affecting the elderly in residential care 
facilities must also be considered: 

• Frail elderly people have very limited 
mobility. Therefore, the residential care 
facility should be accessible and provide 
most community and residential services 
either within the building or on the site. 
Otherwise, the developer may have to 
offer transportation services to facilitate 
occupancy by elderly residents. 

• Older people desire a choice in living 
accommodations. Therefore, a variety 
of living-unit sizes and floor plans 
should be provided. 

• The elderly desire a sense of autonomy, 
and they need an environment that 
extends and enhances their indepen- 
dence. Therefore, the architect should 
provide the special design features and 
details recommended under specific 
rooms and spaces in Part III: A 
Design for Aging Glossary. 



34 II 



Residential Care Facilities 



ENTRANCE LEVEL 





RESIDENTIAL CARE 



II 35 



Residential Care Facilities 



A Main Activity Areas — are centrally 
located; dining is the main activity of 
the day and thus has a primary loca- 
tion in the building. 

B Lounge — offers view of outdoor activ- 
ity and main entries and provides 
waiting area for dining. 

C Elevator — at center of circulation 
path; compact plan shortens travel 
distance. 

D Reception & Administrative Area — 
provides visual control of major 
spaces. 

E Resident Rooms — Shown large 
enough for double or single occu- 
pancy; if all rooms are planned for 
single occupancy, resident wing areas 
can be reduced by 20 percent. 

F Entry — see entry illustration in 
Glossary, Page 90. 

G Corridor Vista — terminates in fur- 
niture alcoves. 

H Kitchen Unit — for resident use. 

I Lounge — located at the center of cir- 
culation to serve meeting, activities, 
promote circulation. 

J Indirect Daylighting — provided at 
end of corridors to diminish glage 
problems. 

K Storage — substantial amounts of 
storage are required for accumulated 
personal possessions. 

L Clustered Entries — enhance a sense 
of private space and allow personal- 
ization. 

MDimensions & Door Swings — permit 
wheelchair access 

N Emergency Call Device — should be 
placed in bathroom if only one is 
called for. 

O Bathroom Door — opens out for emer- 
gency access. 



1 Typical Single Bedroom 

2 Vestibule 


3 
4 
5 


Lounge 
Dining Room 
Mail 


6 Lobby 

7 Reception 

8 Conference 


9 Administration 


10 
11 


Beauty 

M/F Toilets 


12 
13 


Laundry 
Bathroom, Attended 


14 


Kitchen 


15 
16 
17 


Storage 
Staff Lounge 
Male Lockers 


18 


Female Lockers 


19 


Maintenance 


20 


Mechanical 


21 

22 
23 
24 


Janitor's Closet 
Soiled Utility 
Clean Utility 
Trash 


25 


Bath 


Credit: 


Noakes and Associates, Bethesda, 


Maryland 



36 II 



Residential Care Facilities Adjacency 
Matrix 




II 37 



Residential Care Facilities Checklist 



• Older residents of residential care facili- 
ties spend almost all of their time in 
their living units or in common building 
areas. This consideration may affect 
space dimensions, materials, finishes, 
colors, lighting, placement of windows 
and doors, architectural hardware, 
selection of equipment and fixtures (see 
control) and sign systems. 

RESIDENTIAL CARE FACILITIES: 
CHECKLIST 

• Items on the checklist which are in bold 
type and have a page number are keyed 
to Main Entries in the Glossary. 

• Items which are in normal type and 
have a page number are discussed in 
the Glossary on the specified page. 

• Items which are in normal type and 
have no page number are not discussed 
in the Glossary, and the architect is 
expected to use other sources. 

Site Analysis (see Page 128) 
Public Transportation 
Location (see Page 128) 
Neighborhood (see Page 128) 
Security (see Page 125) 
Orientation 
Selection 

Topography (see Page 129) 
Zoning (see Page 129) 
Market (Needs) Analysis 

Site Development (see Page 130) 
Outdoor Spaces (see Page 132) 
Circulation 

• Emergency (police, fire, ambulance) 

• Pedestrian 

• Residents 

• Delivery Service, Garbage Collec- 
tion, Maintenance, Landscaping 
and Groundskeeping Vehicles, 
Snow Removal and/or Storage 



• Staff 

• Vehicular 

• Visitors 
Landscaping (see Page 135) 

• Gardens 

Lighting (see Page 104) 
Outdoor Recreation 

• Checkers/Chess 

• Swimming Pool 

• Tennis 

• Badminton 

• Putting Green/Golf Course 

• Croquet 

• Horseshoes 

• Boccie/Lawn Bowling 
Parking (see Page 135) 

• Barrier- Free (see Page 135) 

• Residents (see Page 136) 

• Staff 

• Visitors 

Patios (see Page 133) 

Seating (see Page 123) 

Security (see Page 125) 

Shelter 

Sign Systems (see Page 126) 

Solar Orientation (see Page 136) 

Water Supply and Sewage Systems 

Entries, Building (see Page 89) 
Barrier-Free (see Page 71) 
Control 

Emergency Exit (see Page 93) 
Main (see Page 89) 
Secondary 

Service (see Page 92) 
Visitors/Staff/Residents 
Lounge (see Page 106) 

Lobby/Reception Areas (see Page 106) 
Control 

Directory (see Page 127) 
Drinking Fountains 
Front Desk 
Seating (see Page 123) 



38 II 



Residential Care Facilities Checklist 



Mail and Package Delivery 

(see Page 109) 

Toilet Rooms, Public (see Page 142) 

Sign Systems (see Page 126) 

Storage 

Telephones (see Page 79) 

Wheelchair Storage 

Waiting Room/Lounge — Visitors' 

Coat Storage 

Office and Administrative Space 

(see Page 114) 

Administrative Services 

Communication Systems 

(see Page 78) 

Control/Security 

Social Services (see Page 138) 

Housekeeping (see Page 99) 
Janitors (see Page 99) 
Linen 

Maintenance 
Receiving 

Storage, Long-Term (see Page 140) 
Trash (see Page 99) 

Vertical Transportation 
Elevators (see Page 88) 
Elevator Lobbies 
Ramps (see Page 117) 
Stairs (see Page 139) 

Central Food Service 

Dining Areas (see Page 85) 

Employee Lockers 

Employee Rest Rooms 

Office — Dietitian 

Floor Kitchens 

Kitchen (see Page 100) 

Service (Receiving) 

Snack Bars (see Page 138) 

Storage 

Trash 

Vending (see Page 138) 



Activity Areas (see Page 63) 
Arts and Crafts (see Page 67) 
Assembly Areas (see Page 69) 
Balconies, Common (see Page 69) 
Chapel (see Page 147) 
Corridors (see Page 83) 
Exercise Areas, Health Club, Fitness 
Facilities (see Page 92) 
Game Rooms 
Green Houses 

Kitchenette/Snack/Dining Area 
Lounges (see Page 106) 
Multipurpose Rooms (see Page 110) 
Performing Arts Areas (see Page 116) 
Reading/Library Areas (see Page 118) 
Skylights 
Swimming Pool 
Sun Rooms (see Page 140) 
Television Viewing Areas 
(see Page 141) 

Residential Services (see Page 119) 
Banking 
Beauty/Barber 

Consultation Room (see Page 82) 
Housekeeping (see Page 99) 
Laundry Facilities (see Page 103) 

• Accessories (see Page 103) 

• Adaptability 

• Auxiliary Heat 

• Storage/Linen 
Nurse/First Aid 
Shops (see Page 126) 

• Gift 

• Grocery 



II 39 



Residential Care Facilities Checklist 



Residents' Units 

Bathrooms (see Page 72) 

• Accessories (see Page 75) 

• Adaptability (see Page 72) 

• Auxiliary Heat 

• Fixtures/Controls (see Page 73) 

• Storage/Linen 
Bedrooms/Living Rooms 
(see Page 75,105) 

• Beds (see Page 76) 

• Furniture/Furnishings 

• Furnishability (see Page 95) 

• Storage/Closets 

• Storage/Furnishings 

• Television 

• Windows/Views (see Page 75) 
Entries (see Page 89) 

• Door/Signage/Identification/Hard- 
ware (see Page 91) 

• Storage (see Page 92) 
Balcony, Private (see Page 69) 

• Seating (see Page 70) 

• Outdoor Access (see Page 70) 
Storage (see Page 140) 
Utilities 

Windows/Views (see Page 145) 
Visitors' Coat Storage 

Mechanical Facilities 

Gross Area Requirements 
Gross/Net Area Requirements 
Airconditioning Requirements 
Electrical Requirements 
Fire-Protection Requirements 
Plumbing Requirements 
Security, Communication Systems and 
Alarms 



40 II 



NURSING HOMES 



Nursing homes are health care facilities 
licensed by a state to provide long-term 
nursing care — as well as custodial care, 
meal service, housing and housekeep- 
ing — within a complete living environ- 
ment. Formal, long-term care facilities 
are the best alternative for the many 
older people who cannot manage in 
more autonomous living environments. 

In 1980, approximately 20,000 nursing 
homes, with 1.4 million residents, were 
located in the United States. Eighty-five 
percent of nursing home residents are 
elderly individuals who, at any given 
time, constitute approximately five per- 
cent of the population of Americans aged 
65 and over. The average nursing home 
resident is 82 years of age on entry; 72 
percent of nursing home residents are 
over 85 years of age. Estimates show a 
20-percent probability that a person will 
spend some time in a nursing home dur- 
ing his or her lifetime. 

Nursing home residents require 24-hour 
nursing care and supervision as well as 
personal care, housekeeping and meal 
services. Residents are often character- 
ized by multiple, chronic diseases and 
disabilities. The majority of nursing 
home residents require assistance with 
bathing, dressing, toileting and mobility. 
Assistance with eating, and bowel and 
bladder hygiene is also frequently 
required. 

Residents of nursing homes tend to fall 
into three major groups: 

• Terminally ill older people who have 
been discharged from a hospital 

• Older people recovering from surgery or frac- 
ture who have been discharged from a 
hospital 



• Medically stable but functionally 
impaired older people who usually have 
been admitted from their homes 

One-third to one-half of nursing home 
residents remain only three months or 
less from the time of admission. These 
residents are primarily from the first two 
groups listed above. About half of these 
residents expire and about half return 
home or are transferred to another 
health care facility. 

Long-stay nursing home residents consti- 
tute the majority of the nursing home 
population at any one time; these resi- 
dents are primarily from the third 
group. 



Major Spaces. The principal form gen- 
erator in nursing homes is the nursing 
unit, which is typically an administrative 
unit that includes up to 60 beds (depend- 
ing upon state regulations) in semi-pri- 
vate and private residents' rooms. The 
nursing unit also typically includes cen- 
tral bath rooms; activity areas, such as 
lounges or day rooms; a group dining 
area, a floor kitchen or serving pantry, 
as required by the food service program, 
and/or a nourishment station; care ser- 
vice areas such as examination and 
treatment rooms, consultation and/or 
conference rooms; housekeeping areas; 
residential service areas; a nursing sta- 
tion; a medication room; storage and 
holding areas for medical equipment, 
wheelchairs and stretchers; circulation 
spaces (corridors), and office and 
administrative support areas. 

Space allocations, equipment and facili- 
ties are frequently controlled by the 



II 41 



Nursing Homes 



requirements of state and/or federal 
codes for the reimbursement of patient 
care costs under the Medicare and/or 
Medicaid provisions of the Social Secu- 
rity Act. Governmental facilities (admin- 
istered by local municipalities or coun- 
ties, the Veterans Administration, the 
Department of Defense or the Public 
Health Service), proprietary facilities and 
those operated by chains may also have 
definitive program and space require- 
ments, including specific space and 
equipment standards furnished by the 
client. 

Programming and Design Considera- 
tions. In general, it is essential that the 
architect understand exactly how each 
space is to function, and who will be 
doing what with whom, using what 
equipment or supplies, requiring what 
storage space and critical dimensions, 
with what specific environmental 
requirements. The programming and 
design procedure considers the human 
needs and values of the elderly, and 
must start with a definition of the type 
and scope of development intended. The 
following considerations must be 
answered to establish that definition: 

• Consider how many beds will be pro- 
vided, in rooms of what type (private or 
semiprivate), of what floor layout and 
area. 

• Consider what type, number and mag- 
nitude of common service facilities (such 
as central dining spaces, activity rooms 
and lounges) will be provided. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
(such as housekeeping, maintenance, 
security and management) will be 
provided. 



• Consider the location of the site, and its 
physical features, size, contours and 
constraints. 

• Consider how much parking will be 
required. 

Development Size and Mix of Resi- 
dents' Rooms. Experience suggests the 
following general rules: 

• Developments should be in multiples of 
40 to 60 beds, or in other nursing unit 
sizes that the client and regulatory 
agencies agree economically justify the 
management, social and nursing care 
services and facilities required for a 
quality level of care. 

• A recommended maximum size of 180 
beds is based on the assumption that a 
high concentration of elderly people 
may tend to encourage their isolation 
from the community, and could possi- 
bly cause abnormal neighborhood devel- 
opment. 

• Each nursing home development should 
offer a variety of types and sizes of resi- 
dents' rooms to accommodate different 
life-styles. The specific mix of residents' 
rooms for each development must be 
determined with the client, and based 
upon its specific marketing context. A 
high proportion of private rooms (up to 
80 percent) is recommended. Residents' 
rooms with three beds or more are not 
recommended because of the resulting 
lack of privacy and personal control. 

Other Factors. These special factors 
affecting the elderly should also be 
considered: 

• The nursing unit should be planned for 
efficient organization, minimum staffing 
and cost, and maximum socialization 



42 II 



Nursing Homes 



and interaction between residents and 
staff (see typical configurations). Maxi- 
mum travel distances for staff are spec- 
ified by state regulations. Layouts can 
be critical to both the quality of resi- 
dents' daily experiences and the eco- 
nomics of the client's operation. 
The nursing unit compresses living and 
activity spaces into a much smaller area 
than most residents have experienced 
before. Elements of the normal residen- 
tial space hierarchy, including front 
porch, entry area and living room 
spaces, are no longer available to separ- 
ate private space from public space. 
Special design consideration must be 
given to mitigating the negative effects 
of the absence of these spaces, including 
careful space planning and detailing in 
the corridors and residents' rooms. 
The resident's room is where he or she 
spends the most time, and thus is the 
space of most importance to residents. 
To the greatest extent possible, resi- 
dents' rooms should have a truly resi- 
dential quality. Residents should have 
the maximum amount of control feasi- 
ble over furniture and furniture arrange- 
ment; over lighting, heating and cooling 
levels, and over the furnishings within 
their rooms. See residents' rooms and 
toilet rooms in Part III: A Design for 
Aging Glossary for a more detailed 
discussion of design considerations. 



The elderly desire a sense of autonomy, 
and they need an environment that 
extends and enhances the duration of 
independent living. Therefore, the 
special design features and details 
recommended under specific rooms and 
spaces in Part III: A Design for Aging 
Glossary should be provided. 
The design of nursing homes must also 
be specially adapted to accommodate 
potential physical limitations. Space and 
dimensions for wheelchair access 
should be provided in all areas of the 
nursing unit (see ANSI A117.1). 
The activities of older people differ from 
those of younger people only in the 
ways that older people are able to per- 
form them. This consideration may 
affect space dimensions, materials, fin- 
ishes, colors, lighting, placement of 
windows and doors, architectural 
hardware, selection of equipment and 
fixtures (see control), and sign systems. 



II 43 



Nursing Homes 



TYPICAL FLOOR 
(TOE-TO-TOE LAYOUT) 




h 



. 








TO-TOI 



^0 



» 



1 



D 



n n 



Single Room Layout 



44 II 



Nursing Homes 



A Side-to-Side Bed Layout & Cross 
Plan — reduce corridor length but 
creates an asymmetrical territorial 
division of the resident room. 

B Toe-to-Toe Room Layout — creates 
longer, narrow wings and longer cor- 
ridors; each resident has a well- 
defined territory or space which others 
do not have to penetrate and a view of 
the outside which does not look 
through the other person's territory; a 
variety of bed placement alternatives 
are possible. 

C Nursing Station — provides visual 
control of entire Nursing Units. 

D Main Lounge — 

• access to outdoor space 

• adjacent to activity and circulation 
nodes 

• provides queuing space for Main 
Dining 

E Main Dining — is the main activity of 
day and thus has a central location in 
the building. 

F Lounge/Dayroom — located adjacent 
to the activity of the Nursing Station 
provides visual interest. 

G Staff & Service Entries — separate 
from main, formal entry. 

H Alcoves — designed to provide indirect 
light and to help block glare in the 
corridor. 

I Entry — set back to help establish 
hierarchy of spaces. 

J Entry Vestibule — provides transition 
space. 

K Personal Territory — delineated by 
ceiling curtain track, includes ward- 
robe, chest, chair and bedside stand. 

L Bathroom Door — opens out for emer- 
gency access. 
M Emergency Call Device — should be 
reachable from floor where the elderly 
person is likely to be. 



1 Typical Single Bedroom 

2 Typical Double Bedroom 

3 Dayroom 

4 Lounge 

5 Laundry 

6 Chapel 

7 Dining Room 

8 Recreation 

9 Gift Shop 

10 Beauty Shop 

11 Lobby 

12 Reception 

13 Administration 

14 Office 

15 Therapy 

16 Treatment Office 

17 Occupational Therapy 

18 Conference 

19 M/F Toilets 

20 Kitchen 

21 Storage 

22 Staff Dining 

23 Male Lockers 

24 Female Lockers 

25 Mechanical 

Credit: 

Noakes and Associates, Bethesda, 
Maryland 



II 45 



Nursing Homes 



TYPICAL FLOOR 
(SIDE-TO-SIDE) 





TYPICAL FLOOR 
(SIDE-BY-SIDE LAYOUT) 



3 



□ 




Single Room Layout 



46 II 



Nursing Homes Adjacency Matrix 



SITE 



ACTIVITY AREAS 



SEATING 



PARKING 



SITE ENTRIES 



BUILDING ACCESS 



LOBBY 



LOUNGE 



SIGNAGE/DIRECTORY 



PUBLIC TOILETS 



PUBLIC TELEPHONES 



ADMINISTRATION 



RECEPTION 



OFFICES 



SOCIAL SERVICES 



SERVICE 



HOUSEKEEPING 



MAINTENANCE 



STORAGE, LONG-TERM 



MECHANICAL SPACES 



LAUNDRY, CENTRAL 



SERVICE ENTRY 



STAFF ENTRY 



STAFF LOCKERS 



CENTRAL FOOD SERVICE 



KITCHEN, COMMERCIAL 



DINING ROOM 



STORAGE, FOOD 



SNACK BARS 



ACTIVITY AREAS 



LOUNGES 



ASSEMBLY/MEETING ROOM 



TELEVISION VIEWING 



GAME ROOM 



ARTS & CRAFTS 



EXERCISE 



PATIENT CORRIDORS 



BALCONIES 



SUNROOMS 



BATHROOMS 



PRIVATE 



CENTRAL 



NURSING UNIT 



RESIDENTS' ROOMS 



NURSING STATION 



NOURISHMENT STATION 



CLEAN/SOILED UTILITY ROOMS 



JANITOR'S CLOSET 



MEDICATION ROOM 




II 47 



Nursing Homes Checklist 



NURSING HOMES: CHECKLIST 

• Items on the checklist which are in bold 
type and have a page number are keyed 
to Main Entries in the Glossary. 

• Items which are in normal type and 
have a page number are discussed in 
the Glossary on the specified page. 

• Items which are in normal type and 
have no page number are not discussed 
in the Glossary, and the architect is 
expected to use other sources. 

Site Analysis (see Page 128) 
Public Transportation 
Location (see Page 128) 
Neighborhood (see Page 128) 
Security (see Page 125) 
Orientation 
Selection 

Topography (see Page 129) 
Zoning (see Page 129) 
Catchment Area and Population 
Market (Needs) Analysis 

Site Development (see Page 130) 
Outdoor Spaces (see Page 132) 
Circulation 

• Emergency (police, fire, ambulance) 

• Pedestrian 

• Residents 

• Delivery Service, Garbage 
Collection, Maintenance, Land- 
scaping and Groundskeeping 
Vehicles, Snow Removal and/ 
or Storage 

• Staff 

• Vehicular 

• Visitors 
Landscaping (see Page 135) 

• Gardens 

Lighting (see Page 104) 
Outdoor Recreation 

• Checkers/Chess 

• Swimming Pool 



• Putting Green 

• Croquet 

• Horseshoes 

• Boccie/Lawn Bowling 
Parking (see Page 135) 

• Barrier- Free (see Page 135) 

• Residents (see Page 136) 

• Staff 

• Visitors 

Patios (see Page 133) 

Seating (see Page 123) 

Security (see Page 125) 

Shelter 

Sign Systems (see Page 126) 

Solar Orientation (see Page 136) 

Water Supply and Sewage Systems 

Entries, Building (see Page 89) 
Barrier-Free (see Page 71) 
Control 

Emergency Exit (see Page 93) 
Main (see Page 89) 
Secondary 

Service (see Page 92) 
Visitors/Staff/Residents 
Lounge (see Page 106) 

Lobby/Reception Areas (see Page 106) 
Control 

Directory (see Page 127) 
Drinking Fountains 
Front Desk 
Gift Shop, Waiting Room 

Area/Lounge 
Seating (see Page 123) 
Mail and Package Delivery 
(see Page 109) 

Toilet Rooms, Public (see Page 142) 
Sign Systems (see Page 126) 
Storage 

Telephones (see Page 79) 
Wheelchair Storage 



48 II 



Nursing Homes Checklist 



Office and Administrative Space 

(see Page 114) 

Administrative Services 

Communication Systems 

(see Page 78) 

Control/Security 

Nursing Services 

Social Services (see Page 138) 

Housekeeping (see Page 99) 
Janitors (see Page 99) 
Linen 

Maintenance 
Receiving 

Storage, Long-Term (see Page 140) 
Trash (see Page 99) 

Vertical Transportation 
Elevators (see Page 88) 
Elevator Lobbies 
Ramps (see Page 117) 
Stairs (see Page 139) 

Central Food Service 

Dining Areas (see Page 85) 

Employee Lockers 

Employee Rest Rooms 

Floor Kitchens/Pantries 

Kitchen (see Page 100) 

Office — Dietitian 

Service (Receiving) 

Snack Bars (see Page 138) 

Storage 

Trash 

Vending (see Page 138) 

Activity Areas (see Page 63) 
Arts and Crafts (see Page 67) 
Assembly Areas (see Page 69) 
Balconies, Common (see Page 69) 
Chapel (see Page 147) 
Corridors (see Page 83) 
Exercise Areas, Health Club, Fitness 
Facilities (see Page 92) 



Game Rooms 

Green Houses 

Lounges (see Page 106) 

Multipurpose Rooms (see Page 110) 

Performing Arts Areas (see Page 11 6) 

Reading/Library Areas (see Page 118) 

Skylights 

Sun Rooms (see Page 140) 

Television Viewing Areas 

(see Page 141) 

Residential Services (see Page 119) 
Banking 
Beauty/Barber 

Consultation Room (see Page 82) 
Housekeeping (see Page 99) 
Laundry Facilities (see Page 103) 

• Accessories (see Page 103) 

• Adaptability 

• Auxiliary Heat 

• Storage/Linen 
Nurse/First Aid 
Shops (see Page 126) 

• Gifts and Flowers 

• Grocery/Sundries 

• Pharmacy/Health Aids 

Residents' Rooms (see Page 119) 
Beds (see Page 76,121) 
Chair (see Page 123) 
Clothing Closet/Storage 
Door/Signage/Identification/Hardware 
Entrance/Foyer/Porch (see Page 120) 
Furnishability (see Page 95) 
Furniture (see Page 122) 
Number of Beds (see Page 119) 
Outdoor Access (see Page 115) 
Privacy/Furnishings (see Page 120) 
Storage (see Page 121) 
Television Viewing Areas 
(see Page 141) 



II 49 



Nursing Homes Checklist 



Toilet Room (see Page 120) 
Windows/ Views (see Page 145) 

Nursing Unit (see Page 40) 

Central Bath Room (see Page 76) 

• Attended Shower (see Page 76) 

• Attended Toilet (see Page 143) 

• Dressing Area (see Page 76) 

• Equipment (see Page 76) 

• Fixtures (see Page 77) 

• Storage (see Page 76) 

Clean and Soiled Utility Rooms 
(see Page 100) 

Dayroom/Lounge/Dining Area 
Linen Room/ Alcoves 
Medication Room (see Page 109) 
Nourishment Station (see Page 111) 
Nursing Station (see Page 112) 

• Call Systems (see Page 78) 

• Charting Counter 

• Nurses' Toilet/Lounge (see Page 112) 

• Reception/Control (mail, telephone, 
paging, staff) 

• Security/ Alarm Systems 
Toilet Rooms (see Page 142) 
Vigil and Visitation Room 
(see Page 144) 



Care Services (see Page 64,112) 
Examination and Treatment 
Room(s) (see Page 92) 
Consultation Room(s) (see Page 82) 
Pharmacy/Health Aids 
Therapy Rooms (see Page 141) 

• Physical (see Page 142) 

• Occupational (see Page 142) 

• Hydro (see Page 141) 

Mechanical Facilities 

Gross Area Requirements 
Gross/Net Area Requirements 
Airconditioning Requirements 
Electrical requirements 
Fire-Protection Requirements 
Plumbing Requirements 
Security, Communication Systems 
and Alarms 



50 II 



CONTINUING CARE RETIREMENT 
COMMUNITIES 



Continuing Care Retirement Communi- 
ties (CCRCs) provide the broadest spec- 
trum of services offered in facilities 
designed for older people. Based on the 
concept of continuum of care, these 
communities allow residents to live com- 
pletely independent life-styles, while 
ensuring that social support, residential 
care and long-term health care will be 
available, whether needed occasionally 
or, at later stages in life, regularly. Typi- 
cally, CCRCs provide independent 
housing, residential care services, 
social services, a senior/community 
center and nursing home care all 
within a single development. 

The concept of CCRCs was formulated 
as a successor to the "life-care commu- 
nity." The life-care concept, under 
which the community sponsor under- 
takes full responsibility for all expenses 
for the resident's long-term care, often 
has proved not to be financially viable, 
largely because of the difficulty of pre- 
dicting and underwriting long-term costs 
of care for small groups. CCRC spon- 
sors have chosen to deal with this liabil- 
ity for long-term health care in a num- 
ber of ways, some of which limit the 
sponsor's overall responsibility to provide 
lifetime care. 

Older people typically begin to consider 
moving into a CCRC when they are rel- 
atively active, mobile and healthy. The 
factor that precipitates a decision to 
move usually involves temporary illness 
or disability, which makes the prospec- 
tive residents apprehensive about their 
ability to sustain themselves in their pre- 
sent living arrangements. It is the 
CCRCs wide range of residential set- 
tings and services, available when and if 



they are needed, and the smooth transi- 
tions between levels of care that attract 
those older people who want a clear set 
of housing and care alternatives, come 
what may. Most CCRC residents move 
in with plans to stay for the rest of their 
lives, a period that may cover 30 to 40 
years. Thus, a CCRC must provide for 
older people who vary greatly in activity, 
mobility and health, encompassing the 
full range from the "go-gos" to the 
"no-gos" described earlier. 

Major Spaces. The major form-generat- 
ing spaces for each of the typical compo- 
nents of a CCRC — elderly housing, 
senior/community center, residential 
care facility and nursing home — were 
presented previously. The general design 
problem for CCRCs is to develop each 
component in response to its own inter- 
nal requirements and, at the same time, 
create relationships between the compo- 
nents that optimize their functions. In 
some CCRCs, residents are housed in a 
single highrise building. Other CCRCs 
offer a mix of residential structures, din- 
ing pavilions, meeting rooms and a 
medical facilities building. Where health 
care services are provided in a separate 
building (such as a nursing home), the 
location, siting and visual screening of 
that building becomes important. CCRC 
residents like to know a nursing home is 
available in the event they need it, but 
they often don't want to be constantly 
reminded of its presence in their daily 
activities. 

Programming and Design Considera- 
tions. Development of a CCRC is a 
complex and manifold endeavor, involv- 
ing the planning, financing, marketing 
and operation of housing, residential 



II 51 



Continuing Care Retirement Communities 



care, senior/community center and nurs- 
ing home facilities. The procedure for 
programming and design considers the 
human needs and values of the elderly, 
and must start with the definition of the 
type and scope of development intended. 
The following considerations must be 
answered to establish that definition: 

• Consider how many elderly-housing 
dwelling units will be provided, of what 
types and floor areas. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
will be provided in elderly housing. 

• Consider how many residential care 
living units will be provided, of what 
types and floor areas. 

• Consider what type, number and mag- 
nitude of common and ancillary services 
and facilities will be provided for resi- 
dential care. 

• Consider how many nursing home 
beds will be provided, in spaces of what 
types and floor areas. 

• Consider what type, number and mag- 
nitude of common and ancillary services 
and facilities will be provided for nurs- 
ing care. 

• Consider what type, number and mag- 
nitude of central common service facil- 
ities (such as central dining spaces, 
activity spaces and lounges) will be pro- 
vided in the senior/community center. 

• Consider what type, number and mag- 
nitude of ancillary services and facilities 
(such as housekeeping, maintenance, 
security and management) will be pro- 
vided in the senior/community center. 

• Consider the location of the site, and its 
physical features, size, contours and 
constraints. 

• Consider the amount of parking to be 
required, and how it should be allocated 



among the various components on the 
site. 

Development Size and Dwelling Unit 
Mix. CCRCs account for approximately 
one-third of all retirement communities 
nationwide. Each generally houses a 
total of 300 to 500 residents, which has 
proved to be an economically viable pop- 
ulation range and which also allows for 
the design of a noninstitutional environ- 
ment in which older people can live with 
comfort and dignity. 

Experience suggests the following general 
rules: 

• A CCRC should generally house a total 
of 300 to 500 residents, to economically 
justify the needed management, services 
and health care. 

• The recommendations made for each 
landmark facility type presented in this 
section should be followed regarding 
maximum development size, range of 
dwelling/living/residents' room types 
and sizes. Quantities and distribution of 
services and facilities should be 
reviewed, however, in light of the cen- 
tralization of services (except for health 
care) and the captive market provided 
by the other levels of care. 

• The specific component mix for each 
CCRC development must be deter- 
mined through market and demo- 
graphic studies, and with the client. 
When a CCRC first opens, higher 
levels of care (residential care and the 
nursing home) may be underused if 
nonresidents are not allowed access to 
the facilities. Planning should be based 
on need for the various levels of care as 
that need is projected for five and ten 
years in the future, however, when 



52 II 



Continuing Care Retirement Communities 



Continuing Care Retirement 
Communities — are the conglomeration 
of all the other facility types and services 
into one building or campus-like group 
of buildings. 
A Ground Level — provides the services 

and functions of a community (senior) 

center for the CCRC. 
B Main Lounge — 

• access to outdoor space 

• adjacent to activity and circulation 
nodes 

• provides queuing space for Main 
Dining 

C Main Dining — is the main activity of 
the day and thus has a central location 
adjacent to the elevators of the high- 
rise. 

D Nursing Care — located on second 
floor because of heavy volume of 
visitor traffic and service delivery. 

E Resident's Room — side-by- side except 
that two piece toilet is on corridor 
rather than between rooms; refer to 
side-by- side Nursing Home for room 
layout. 

F Roof — of ground level portion of the 
building carefully designed to be 
aesthetic and attractive because of 
prominence in view from tower 
behind. 

G Alcoves — end-of-corridor alcove 
designed to provide indirect light and 
diminish glare problems. 

H Overhang — helps to reduce sky glare; 
potential glare problems may require 
curtains or external glazing. 

I Dayroom — offers good views of out- 
door activities. 

J Corridor — width diminishes to 6 feet 
on residential floors from the 8 feet 
required on nursing level. 

K One Bedroom Unit — refer to unit 
plans for Elderly Housing. 



L Two Bedroom Unit — refer to unit 

plans for Elderly Housing. 
M Storage — Out of unit storage for 

accumulated personal belongings is 

essential. 
N Residential Unit — refer to unit plan 

for Residential Care 

1 Single Bedroom 

2 Double Bedroom 
l*One Bedroom Unit 
2*Two Bedroom Unit 

3 Lounge 

4 Laundry 

5 Coffee Shop 

6 Library 

7 Exercise Area 

8 Arts & Crafts Area - 

9 Games 

10 Dining 

11 Pharmacy 

12 Clinic 

13 Mail 

14 Coats 

15 Assembly 

16 Therapy 

17 Conference 

18 Administration 

19 M/F Toilets 

20 Resident Storage 

21 Medication Room 

22 Kitchen 

23 Soiled Utility 

24 Clean Utility 

25 Mechanical 

26 Lockers 

27 Storage 

28 Nurses Lounge 

29 Central Bath 

30 Trash 

Credit: 

Noakes and Associates, Bethesda, 
Maryland 



II 53 



Continuing Care Retirement Communities 




t 



LS2LJ M 
115. 



FT 

J I 



7 | i6 \m 



8 



18' 

T 



H 



-^ DSEfl 
17 



18 



i j 



17 



15 



GROUND LEVEL AND SITE PLAN 




RESIDENTIAL CARE FLOOR 



54 II 



Continuing Care Retirement Communities 



NURSING CARE FLOOR 




5 



2 




m 

MM 





.- 



sip 










e: 






S 



ELDERLY HOUSING-TYPICAL FLOOR 




II 55 



Continuing Care Retirement Communities 



many of the presently active residents 
will require higher levels of care. 

Other Factors. These special factors 
affecting the elderly should also be 
considered: 

• All of the recommendations for the 
landmark facility types described in Part 
II also apply to those facilities when 
they are components of a CCPvC. 

• In the interests of financial success and 
stability, many of these multilevel-care 
facilities are working to attract younger 
residents who will stay for a number of 
years without requiring extensive medi- 
cal services. Two-bedroom detached 
units of 1,000 to 1,300 square feet are 
generally built to attract this clientele, 
although such single-family dwellings 
and cottages currently (1985) constitute 
less than two percent of the housing 
offered in continuing care facilities. 



One major component of the typical 
CCRC is the community center. It 
serves many of the functions of a senior 
center; it also provides such residential 
services as a bank and a pharmacy. 
And depending upon the size of the. 
CCRC and the market in the surround- 
ing community, it might also furnish 
space for medical offices or an adult day 
care center, and/or a wellness clinic. 
The community center is often the focal 
point of the community, providing the 
main entrance to the total facility and 
serving as the site of most group activi- 
ties. Other elements do not differ sub- 
stantially from those described in the 
other sections of this chapter, although 
the site considerations can be signifi- 
cantly different. 



56 II 



Continuing Care Retirement Communities 
Checklist 



CONTINUING CARE 
RETIREMENT COMMUNITIES: 
CHECKLIST 

• Items on the checklist which are in bold 
type and have a page number are keyed 
to Main Entries in the Glossary. 

• Items which are in normal type and 
have a page number are discussed in 
the Glossary on the specified page. 

• Items which are in normal type and 
have no page number are not discussed 
in the Glossary, and the architect is 
expected to use other sources. 

Site Analysis (see Page 128) 
Public Transportation 
Location (see Page 128) 
Neighborhood (see Page 128) 
Security (see Page 125) 
Orientation 
Selection 

Topography (see Page 129) 
Zoning (see Page 129) 
Market (Needs) Analysis 

Site Development (see Page 130) 
Outdoor Spaces (see Page 132) 
Circulation 

• Emergency (police, fire, ambulance) 

• Pedestrian 

• Residents 

• Delivery Service, Garbage 
Collection, Maintenance, Landscap- 
ing and Groundskeeping Vehicles, 
Snow Removal and/or Storage 

• Staff 

• Vehicular 

• Visitors 
Landscaping (see Page 135) 

• Gardens 

Lighting (see Page 104) 
Outdoor Recreation 

• Checkers/Chess 



• Swimming Pool(s) 

• Tennis 

• Badminton 

• Putting Green 

• Golf Courses 

• Croquet 

• Horseshoes 

• Boccie/Lawn Bowling 
Parking (see Page 135) 

• Barrier- Free (see Page 135) 

• Residents (see Page 136) 

• Staff 

• Visitors 

Patios (see Page 133) 

Seating (see Page 123) 

Security (see Page 125) 

Shelter 

Sign Systems (see Page 126) 

Solar Orientation (see Page 136) 

Water Supply and Sewage Systems 

Entries, Building (see Page 89) 
Barrier-Free (see Page 71) 
Control 

Emergency Exit (see Page 93) 
Main (see Page 89) 
Secondary 

Service (see Page 92) 
Visitors/Staff/Residents 
Lounge (see Page 106) 

Lobby /Reception Areas (see Page 106) 
Control 

Directory (see Page 127) 
Drinking Fountains 
Front Desk 
Gift Shop, Waiting Room 

Area/Lounge 
Seating (see Page 123) 
Mail and Package Delivery 
(see Page 109) 

Toilet Rooms, Public (see Page 142) 
Sign Systems (see Page 126) 
Storage 



II 57 



Continuing Care Retirement Communities 

Checklist 



Telephones (see Page 79) 
Wheelchair Storage 

Office and Administrative Space 

(see Page 114) 

Administrative Services 

Communication Systems 

(see Page 78) 

Control/Security 

Social Services (see Page 138) 

Housekeeping (see Page 99) 
Janitors (see Page 99) 
Linen 

Maintenance 
Receiving 

Storage, Long-Term (see Page 140) 
Trash (see Page 99) 

Vertical Transportation 
Elevators (see Page 88) 
Elevator Lobbies 
Ramps (see Page 117) 
Stairs (see Page 139) 

Central Food Service 

Dining Areas (see Page 85) 

Employee Lockers 

Employee Rest Rooms 

Floor Kitchens/Pantries 

Kitchen (see Page 100) 

Office — Dietitian 

Service (Receiving) 

Snack Bars (see Page 138) 

Storage 

Trash 

Vending (see Page 138) 

Activity Areas (see Page 63) 
Arts and Crafts (see Page 67) 
Assembly Areas (see Page 69) 
Balconies, Common (see Page 69) 
Chapel (see Page 147) 
Corridors (see Page 83) 
Exercise Areas, Health Club, Fitness 



Facilities (see Page 92) 

Game Rooms 

Green Houses 

Lounges (see Page 106) 

Multipurpose Rooms (see Page 110) 

Performing Arts Areas (see Page 116) 

Reading/Library Areas (see Page 118) 

Skylights 

Sun Rooms (see Page 140) 

Television Viewing Areas 

(see Page 141) 

Mechanical Facilities 

Gross Area Requirements 
Gross/Net Area Requirements 
Airconditioning Requirements 
Electrical Requirements 
Fire-Protection Requirements 
Plumbing Requirements 
Security, Communication Systems 
and Alarms 

**SEE OTHER MAJOR BUILDING 
TYPE CHECKLISTS FOR 
BUILDING-RELATED ITEMS. 

Elderly Housing Checklist 

Residential Services (see Page 24) 
Dwelling Units (see Page 25) 

Senior Center Checklist 

Existing Building Evaluation for 
Renovation (see Page 31) 
Care Services (see Page 31) 

Residential Care Facilities Checklist 

Residents' Units (see Page 38) 

Nursing Homes Checklist 

Residents' Rooms (see Page 48) 
Nursing Unit (see Page 49) 
Care Services (see Page 49) 



Ill 59 



III GLOSSARY 

Contents 



Accessory Apartments 62 

Activity Areas 62 

Adaptability 63 

Adaptive Reuse 64 

Adult Day Care 64 

Alcoves 65 

ANSIA117.1 65 

Architectural Hardware 66 

Area Requirements 67 

Arts and Crafts Areas 67 

Assembly Areas 69 

Balconies 69 

Barrier-Free Design 71 

Bathrooms, Private 72 

Bedrooms, Housing 75 

Beds 76 

Central Bathing (Nursing Homes) 76 

Communication Systems 78 

Community Spaces 80 

Congregate Housing 81 

Consultation Room 82 

Continuum of Care 82 

Control 83 

Corridors 83 

Dining Areas 85 

Doors 87 

Elevators 88 

Emergency Care 89 

Entries 89 

Examination and Treatment Room 92 

Exercise Areas 92 

Exits 93 

Finishes 94 

Furnishability 95 

Granny Flats 95 

Group Homes 95 

Handrails 96 

Heating, Ventilating and Airconditioning 97 

Home Care 98 

Hospice Care 99 

Housekeeping 99 

Kitchens 100 



60 III 



Contents 



Laundry Facilities 103 

Lighting 104 

Living/Dining Room 105 

Lobby/Reception Areas 106 

Long-Term Care 106 

Lounges 106 

Mail and Package Delivery 109 

Medication Room 109 

Mobile Homes 110 

Multipurpose Rooms 110 

Nourishment Station Ill 

Nursing Care 112 

Nursing Station 112 

Office and Administrative Space 114 

Outdoor Access 115 

Performing Arts Areas 116 

Personal Care 116 

Privacy j 117 

Ramps 117 

Reading/Library Areas 118 

Redundant Cueing 118 

Residential Services 119 

Residents' Rooms (Nursing Homes) 119 

Respite Care 122 

Retirement Communities 122 

Safety 123 

Seating 123 

Security 125 

Senile Dementia 125 

Shops 126 

Sign Systems 126 

Site Analysis 128 

Site Development 130 

Snack Bars 138 

Social Services 138 

Sound Control 138 

Space Hierarchy 139 

Stairs 139 

Storage 140 

Sun Rooms , 140 

Tactile Cues 141 

Television Viewing Areas 141 

Therapy Rooms 141 

Toilet Rooms 142 



Ill 61 



Contents 



Uniform Federal Accessibility Standards (UFAS) 143 

Vigil/Visitation Room 144 

Wayfinding 144 

Wheelchair Accessibility 145 

Windows 145 

Worship and Meditation Room 147 



62 III 



Accessory Apartments 



ACCESSORY APARTMENTS 

An accessory apartment is typically a 
rental unit created by subdividing the 
space of an existing dwelling owned by 
an older person, and providing a separ- 
ate kitchen and bathroom for the newly 
created unit. Accessory apartments pro- 
vide many older homeowners with the 
means and support they need to continue 
living in their existing homes and neigh- 
borhoods; the rental unit provides the 
homeowner with both additional income 
and the security of having others close 
by in case of emergency. Renters may 
also help maintain the property as a part 
of their rent — help that can be especially 
useful to older people who have difficulty 
taking care of their own homes. 

Frequently, middle-aged family members 
will accommodate an older relation by 
creating an accessory apartment in their 
own dwelling unit — by remodeling a 
garage for example, or constructing an 
addition to a single-family house. This 
kind of accessory apartment is similar to 
a granny flat — a temporary, free stand- 
ing unit erected on the site of an existing 
house for use by older family members. 

Many local jurisdictions have revised 
their zoning ordinances to allow the 
development of accessory apartments in 
single-family housing zones. The zoning 
ordinance sections dealing with accessory 
apartments usually contain special 
requirements, such as a minimum lot 
size, on-site parking, separate entries, 
above-grade windows and other basic 
facilities. They may also require special 
applications, hearings, inspections, fees 
and reviews. 



Some local jurisdictions oppose accessory 
apartments because they permanently 
increase previously planned densities. In 
such instances, granny flats may be 
more attractive to local authorities 
because typical zoning requires that they 
be removed when the elderly occupant of 
the unit dies or leaves permanently. 
Also see Granny Flats and Site 
Analysis. 

ACTIVITY AREAS 

Given the substantial quotient of leisure 
time available to users in many facilities 
for aging, activities are second only to 
physical care as a main determinant of 
the quality of life for those users. What 
do they do — or wish to do— with their 
leisure time? A recent survey (see page 
163, NCCNHR) sought that informa- 
tion from 455 residents of 107 nursing 
homes across the country, and collated 
answers that may be helpful to facility 
programmers. "More and better 
choices" among activities was a leading 
response to the survey, as was the 
request for "increased activities during 
the evenings and on weekends." 

Asked what activities they favored, the 
surveyed users put social activities at the 
head of the list, and included the arts 
(fine arts, crafts and music) and intellec- 
tually stimulating activities in the top 10. 
Among the other kinds of activities 
requested were sports, exercise pro- 
grams, swimming, religious programs, 
more programs involving community 
participation and more programs con- 
ducted outside the facility. The users 
also voiced an interest in growing their 
own vegetables, cooking their own food, 
raising chickens and fishing. 



Ill 63 



Adaptability 



Though pets were not mentioned in the 
study, the companionship they provide 
can often contribute significantly to the 
overall well being of the elderly. This is, 
however, more a programming than 
design issue. 

As for other preferences, these nursing 
home residents stressed their need for 
privacy, and for full accessibility (citing 
accessible vans and buses for transporta- 
tion, accessible walkways outdoors and 
ramps indoors and out); they wanted 
more control over the television's on-off 
switch and its volume, and, finally, they 
sought to exercise the choice of whether 
or not to live in a nursing home. 

Facilitating group activities is often an 
important program goal in buildings 
designed for the elderly. Unfortunately, 
the activity spaces designed for this pur- 
pose often go unused because elderly 
residents reject them for their architec- 
tural failure to accommodate user needs 
or perceptions. In perhaps no other spe- 
cific area is it more important for the 
architect to communicate with users and 
research the problems and successes 
experienced elsewhere before initiating 
design. 

The basic reason behind the inclusion of 
activity areas in facilities for the elderly: 
Many activities commonly undertaken at 
multiple remote sites by younger people 
are provided on a single site for older 
people to assure accessibility and to stim- 
ulate participation. Activity areas vary 
according to building types and facility 
sizes. 



See the following glossary entries for 
specific rooms or spaces: Alcoves, Arts 
and Crafts Areas, Assembly Areas, 
Balconies, Corridors, Exercise Areas, 
Laundry Facilities, Lounges, Multi- 
purpose Rooms, Performing Arts 
Areas, Outdoor Access, Reading/ 
Library Areas, Sun Rooms, Television 
Viewing Rooms, Worship and Medita- 
tion Areas, and Senior Centers in Part 
II: Facility Types. 

ADAPTABILITY 

Older people experience a wide variety 
of age-related impairments over time. As 
a result of this great variety among dif- 
ferent elderly people, and the changes 
they can undergo, a single room design 
seldom fits exactly the specific require- 
ments of different older people. Their 
individual differences create design 
requirement differences that are especi- 
ally important in the dwelling unit 
kitchens and bathrooms. 

Adaptability is a design concept devel- 
oped to address these problems of indi- 
vidual differences and individual changes 
in capability over time. ANSI Al 17.1 
defines adaptability as "the ability of cer- 
tain building elements, such as kitchen 
counters, sinks, and grab bars, to be 
added to, raised, lowered, or otherwise 
altered so as to accommodate the needs 
of either the disabled or nondisabled, or 
to accommodate the needs of persons 
with different types or degrees of 
disability." 

In addition to adjustable building 
elements, adaptable dwelling units are 
wheelchair accessible (see ANSI Al 17.1) 
and offer special features such as lever 
handles on all doors, larger bathrooms, 



64 III 



Adaptability 



flexible shower hoses, grounds for future 
grab bars, antiscald shower controls, 
front-loading washers and dryers, 
24-inch-high electrical outlets, 48-inch- 
high light switches, side-by-side refriger- 
ator/freezers, front range controls, 
sliding or casement windows and loop 
cabinet hardware. 

The average additional costs of these 
items — over and above the costs of items 
normally specified for housing — amount 
(in 1985) to less than $700 per dwelling 
unit. If and when grab bars, a strobe- 
light doorbell and a flashing smoke 
alarm are added in the future, further 
added costs will be approximately $500. 
These costs are insignificant when com- 
pared with the costs of relocating an 
older person who must move from 
unadaptable housing as a result of minor 
or temporary impairment. 

Also see Bathrooms and Kitchens. 

ADAPTIVE REUSE 

This design guide has been written with 
new construction in mind but virtually 
all of the information contained within is 
appropriate for architects to use in the 
process of adapting aging facilities into 
existing structures. 

A recent survey by the U.S. Conference 
of Mayors on elderly housing found 
adaptive reuse projects underway in over 
100 cities. Former schools and hotels 
appeared to be the most popular build- 
ing types. Other types found were hospi- 
tals, factories, warehouses, office build- 
ings, convents, churches, retail stores, 
banks, large residences, dormitories, 
armories, parking garages, firehouses, 
children's homes, and a car wash. 



ADULT DAY CARE 

Adult day care centers provide health 
and social services for elderly people who 
are ill and/or disabled (as opposed to 
community and senior "wellness" cen- 
ters, which focus on exercise, nutrition 
and other activities for the healthy 
elderly). Typically, the older person is 
transported to the adult day care center 
by his or her primary care- giver (often 
an adult relative) in the morning and 
picked up again in the late afternoon. 
However, many adult day care centers 
also provide transportation to and from 
the facility. 

Limited studies of adult day care partici- 
pants have found that more than half 
need assistance with eating, transferring 
from bed to chair and/or toileting. Ser- 
vices vary among different programs but 
frequently include supervision, personal 
care, group and individual activities, 
meals, recreation and exercise, in addi- 
tion to medical and related services such 
as physical therapy and speech therapy. 

Two general types of adult day care 
have been identified: 

• Medically oriented programs, designed pri- 
marily to provide intensive health care 
and physical therapy, and 

• Recreationally and educationally oriented pro- 
grams, designed to provide activities as 
well as social and intellectual stimula- 
tion for impaired and isolated elderly 
individuals, in addition to respite for the 
families who have been caring for them. 

Some adult day care programs operate 
within facilities designed for other pur- 
poses, such as nursing homes, where the 
environment, staff and services are 
related and may be shared. This 



Ill 65 



ANSI A117.1 



arrangement is one way for a nursing 
home to extend its programs by using 
existing expertise to provide an alterna- 
tive to institutional care. 

Also see Personal Care. 

ALCOVES 

Alcoves in activity areas, corridors, 
lobby/reception areas and lounges pro- 
vide semiprivate spaces where people can 
meet and converse. By helping to divide 
larger spaces into niches that may better 
facilitate small group-activities, alcoves 
can be especially important in nursing 
homes and other facilities that provide 
reduced semiprivate space. 

Wide or multiple alcoves along a corri- 
dor can be detrimental to independent 
mobility by breaking up the continuity 
of the handrails. Freestanding handrails 
along the perimeter of a corridor alcove 
should be provided wherever a major 
break in the continuity of the handrails 
would otherwise occur. 




Lafayette Place 

Fall River, Massachusetts 

Boston Architectural Team, Inc. 

Hresko Associates, Boston 
Phillip Hresko, Principal 
David Clark, Job Captain 

Nick Wheeler, Photographer 



Also see Corridors, Lobby/Reception 




Alcoves provide semi-private space for 
social interaction. 



Areas, Lounges, Space Hierarchy, and 
Nursing Homes in Part II: Facility 
Types. 

ANSI A117.1 

The American National Standard Specifica- 
tions/or Making Buildings and Facilities 
Accessible To and Usable By Physically Dis- 
abled People (ANSI All 7.1) is published 
by the American National Standards 
Institute. Scheduled for revision every 
five years, this consensus standard 
focuses on minimum design require- 
ments for physically disabled people of 
all ages; it should not be construed as 



66 III 



ANSI A117.1 



presenting the optimal criteria for build- 
ings serving severely disabled users on an 
everyday basis. 

While most older people are not physi- 
cally disabled, multiple age-related physi- 
cal impairments of a more minor nature 
are common. Therefore, accessibility and 
usability are prerequisites for design for 
aging, and that is why ANSI A117.1 
and similar standards are referenced in 
this guide. 

Also see Barrier-Free Design, Bath- 
rooms, Uniform Federal Accessibility 
Standards (UFAS). 

ARCHITECTURAL HARDWARE 

Architectural hardware for doors and 
windows should be operable with one 
hand and not require excessive strength 
or a tight grip for twisting or turning. 
Lever handles, push plates, and 
U-shaped pulls are recommended, 
mounted between 15 and 48 inches 
above the floor. Limit the pressure 
required to open doors controlled by 
spring hinges and door-closers to 3 to 5 
foot-pounds and provide door closers 
with a check- action delay of 4 to 6 
seconds before starting to close. 

Also see Barrier-Free Design, Doors, 
Control, Security, Windows and refer 
to barrier- free design standards. 







Levers are far more manageable than round 
knobs as grip strength diminishes. 



Ill 67 



Arts and Crafts Areas 



AREA REQUIREMENTS 

As a result of the prominence of low- 
income elderly housing programs, there 
has been a tendency to adopt minimum 
standards that assume older people 
somehow require less floor area to carry 
out their daily activities, tasks and enter- 
tainments than do younger people. On 
the contrary, elderly people often need 
more space to support their life styles. 

Older people spend more time inside 
fewer spaces and buildings than do 
younger people, and they frequently util- 
ize mobility aids that require more clear- 
ance in circulation spaces. In private and 
semiprivate space, older persons may 
require the assistance of another person 
to carry out common activities of daily 
living, and often own large collections of 
artifacts — and oversized furniture — to 
which they are strongly attached. At the 
same time, in semipublic and public 
spaces, older persons often gather in 
small groups; overly large areas can 
cause them to feel lost or overwhelmed 
in excessive space, as well as give the 
appearance of underactivity. The archi- 
tect should recognize the elderly 's use of 
indoor spaces as well as their special 
mobility problems, assistance require- 
ments, life styles and group sizes when 
planning space and setting area 
requirements. 

In the past, governmental agencies have 
published guidelines for low-income 
housing, such as the U.S. Department of 
Housing and Urban Development's 
Minimum Property Standards, to estab- 
lish minimum area requirements for 
governmentally financed projects. Today 



such standards are often obsolete, and 
yet still enforced as maximums by cost 
conscious regulatory agencies. Architects 
have to convince project sponsors that 
the needs of the elderly are bona fide, 
and that long-term competitive advan- 
tages can be realized by project sponsors 
and operators whose amenities and ade- 
quate spaces help attract and maintain 
full occupancy, even when a market 
becomes saturated by competition. 

Also see Space Hierarchy. 

ARTS AND CRAFTS AREAS 

Spaces devoted to arts, crafts and other 
creative hobbies can be difficult to plan 
because of the wide variety of activities 
that may take place. Arts and crafts 
activities such as painting and sketching 
require little space and few provisions 
beyond adequate task lighting and stor- 
age. Arts and crafts — woodworking, 
ceramics, china painting. and photog- 
raphy — can require more space as well 
as special furniture, equipment, electrical 
service, plumbing fixtures, exhaust ven- 
tilation systems and storage. 

Consider locating some arts and crafts 
spaces where visitors and others can 
view the activities. Although participants 
should be able to control this visual 
access with curtains or other means, 
such visibility for arts and crafts activi- 
ties can encourage wider participation. 

Isolate and contain noisy and dirty activ- 
ities. Crafts such as weaving and wood- 
working, which require fixed equipment, 
can be confined to single-use rooms. 



68 III 



Arts and Crafts Areas 




□ 



HEAVY ACTIVITY 



io i@o loo \p*?4%T 



31 



MULTI-PURPOSE SPACE 




Arts & Crafts Areas are important and much used spaces. 



Provide adequate safety devices for dan- 
gerous equipment such as woodworking 
tools and kilns. 

The design of storage is important. Stor- 
age for works-in-progress should be 
accessible (mounted at a height between 
shoulder and knee) and of a size appro- 
priate to the stored objects; the space 
might also serve to display works com- 
pleted or in progress. Shelving and 
cubicles should not be so deep that par- 



ticipants cannot reach to the back. Stor- 
age for works-in-progress, materials and 
tools belonging to individuals should be 
both accessible and secure. Communal 
material, tool and equipment storage 
should be separate from individual stor- 
age and provide convenient, controlled 
access. Movable storage units can be 
used as flexible space dividers. 

Also see Activity Areas and Lighting. 



Ill 69 



Balconies 



ASSEMBLY AREAS 

Locate assembly rooms near lobby or 
lounge areas. Where seating is fixed, 
provide aisles that are a minimum of 42 
inches wide to allow for the movement 
of wheelchairs and walkers, and suffi- 
cient wheelchair spaces should be pro- 
vided (see ANSI A117.1 or applicable 
barrier-free design standards). Provide a 
minimum of 40 inches for back-to-back 
row spacing. Provide firm, upholstered 
seating that is 14 to 16 inches high in 
the front and 22 to 30 inches wide, with 
armrests 7 to 8 inches above the seat 
and extending beyond the seat front. 

Provide an accessible stage or other per- 
forming arts area usable for dance, 
theater and music. A good, distortion- 
free public address system is important. 
Provide a listening system for hearing 
impaired older users that utilizes an FM, 
infrared, induction or other equally 
effective interior transmission system 
with individual headsets. A projection 
room is recommended to eliminate back- 
ground noise from a projector, which 
can be bothersome to many older 
people. 

In senior centers and particularly in 
larger facilities, consider the need for a 
space devoted solely to meetings; small 
centers with lower daily attendance can 
often utilize other rooms, including 
lounges, dining areas or multipurpose 
rooms, as meeting spaces. 

Also see Activity Areas, Barrier-Free 
Design, Dining Areas, Lounges, 
Multipurpose Rooms, Seating, Senior 
Centers in Part II: Facility Types, and 

refer to barrier- free design standards. 




S ARMREST HEIGHT 
1 T14"T0 16" '40" BACK TO BACK 
SEAT HEIGHT ROW SPACING 



Assembly Areas— Flexible spaces in public 
theaters allow families and friends to sit with 
elderly patrons. 



BALCONIES 

Balconies can be valuable sources of 
access to the outdoor environment for 
older people in buildings above one story 
in height. Depending on the level of 
security desired, balcony functions can 
be fulfilled by glassed-in sunrooms, 
screened porches or private balconies 
separated from living units by glass 
doors. 

Provide balconies that look and feel safe, 
but that don't block views from the 
building's interior or from a seated posi- 
tion on the balcony itself. Provide guard- 
rails 42 inches in height, with openings 
small enough to prevent a baby from 
slipping through. Design balustrades and 
rails with narrow-profile materials to 
minimize impact on views. Avoid solid 
parapets that block views. Provide 
guardrails and mountings with sufficient 
strength to meet the requirements of 



70 III 



Balconies 



6'-0" MIN. 





SECTION 



Balconies provide the valuable amenity of 
access to the outdoors. 



applicable building codes and ANSI 
A117.1 (generally a force of 250 pounds 
applied in any direction for rail bending 
and shear stress, as well as for fastener 
shear and tensile force). 

Common Balconies. Provide an area of 
sufficient size to accommodate both 
group and individual activities; a general 
rule of thumb is to provide 60 square 
feet, plus an additional five-square feet 
for each anticipated occupant. Plan the 
space to accommodate the furniture and 
equipment required for anticipated activ- 
ities. Design access so that users can 
visually survey all areas of the common 
balcony before entering. Provide control 
for lighting from an inside switch. Isolate 
the common balcony, both visually and 
audibly, from private interior spaces. 

Private Residential Balconies. Provide 
sufficient space to accommodate two 
chairs and a table — usually 50 to 60 
square feet. Minimum dimensions are 
critical: Less than five feet in any dimen- 
sion means that two people will be 
forced to sit side-by-side, rather than in 
the much preferred face-to-face seating 
arrangement. 

Primary design goals are to provide 
visual and audible privacy and good 
views of site activity and esthetic ameni- 
ties to the balcony users. A built-in ledge 
for supporting potted plants and flowers 
(located away from the main view) can 



Ill 71 



Barrier-Free Design 



be helpful. Private balconies often are 
used by older residents to store seldom- 
used items, especially when storage space 
inside the unit is limited; storage space 
built into the balcony can help to protect 
these possessions from the elements while 
reducing balcony clutter. 

Also see Activity Areas, Outdoor 
Access, Site Development, and Elderly 
Housing in Part II: Facility Types. 

BARRIER-FREE DESIGN 

Barrier-free design refers to both the dis- 
cipline of and the principles involved in 
the selection and design of sites, build- 
ings, fixtures, equipment and furniture 
that are accessible to and usable by all 
people, including those with physical 
impairments. Parts of the built environ- 
ment that are not accessible to and 
usable by physically impaired people are 
viewed as having "barriers." 

The American National Standards Insti- 
tute (ANSI) has established standards for 
barrier-free design that have been incor- 
porated into most state and local codes. 
In addition, the U.S. Architectural and 
Transportation Barriers Compliance 
Board (ATBCB) has established mini- 
mum guidelines and requirements for 
use by federal standard-setting agencies 
in developing standards for application 
under the Architectural Barriers Act of 



1968. Each agency of the federal govern- 
ment is required by the Barriers Act to 
adopt accessibility standards. To fulfill 
this requirement, the Uniform Federal 
Accessibility Standards (UFAS) have been 
developed to serve as the sole accessibil- 
ity standard to be referenced by the fed- 
eral government. 

Barrier-free design is a necessary compo- 
nent of design for aging. The principles, 
standards and guidelines of barrier-free 
design are essential to any architect 
interested in ensuring accessibility and 
usability for older users. When designing 
for older users, however, the architect 
must also attend to the many other 
design requirements of the elderly, 
requirements that often go beyond 
barrier-free design and stem from 
cognitive, social and psychological as 
well as physical impairments. In addi- 
tion, the elements, fixtures, equipment 
and furniture selected by the architect to 
create a barrier-free environment for the 
older person should blend into the nor- 
mal ambience of the building type, 
rather than create the image of an overly 
supportive or prosthetic environment. 

Also see Adaptability, ANSI A117.1, 
Control, Uniform Federal Accessibility 
Standards, and Part I: Introduc- 
tion — Aging and the Environment. 



72 III 



Bathrooms, Private 



BATHROOMS, PRIVATE 

The general design considerations of pri- 
vate bathrooms for older users hinge on 
a wide range of issues. Among them: 

• Accessibility. Design the bathroom to 
avoid floor level changes and to accom- 
modate a second person who might pro- 
vide assistance. Provide bathroom 
plumbing fixtures that are accessible 
from a wheel chair (see ANSI A117.1 
or applicable barrier-free design stan- 
dards). Provide bathroom doors that 
swing out (or are capable of swinging 
out in an emergency), so that the door 
can be opened when an incapacitated 
person is lying on the floor and blocking 
the inward swing of the door. 



• Adaptability. An adaptable bathroom 
provides the flexibility and support 
required for continued usage by older 
people as they experience age-related 
diseases or disabilities, and yet does not 
intrude with such support when it is not 
needed. Reinforced mounting points for 
potential grab bar installation and suffi- 
cient space for wheelchair access and 
bathing assistance are among the basic 
provisions for adaptability. 

• Emergency Call Systems. A high pro- 
portion of calls for assistance originate 
in the bathroom, in part because the 
bathing-drying-dressing activities that 
take place there increase the likelihood 



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(Plan & Section) Bathrooms, Private— This bathroom is shown generously large to illustrate the 
features described. Other bathroom layouts are shown in Part II: Facility Types. 



Ill 73 



Bathrooms, Private 



of accident, and in part because the 
bathroom is where many people go 
when they feel ill. Provide an emer- 
gency communication system in all 
bathrooms in facilities designed for 
older users. Provide a call system that, 
when activated, alerts parties capable of 
responding quickly to the call at any 
time the bathroom might be in use. 
Consult with the client to program a 
viable location for alarm monitoring, 
that will facilitate an appropriate 
response 24 hours a day. 

In private bathrooms, the emergency call 
system should be within the reach of a 
person seated on the toilet, in the 
bathtub, in the shower or lying on the 
floor. A simple switch, mounted on the 
wall 36 inches above the floor, with a 
3/8-inch rod attached, and extending 
within four inches of the floor serves 
well. The rod should be of a color that 
contrasts highly with the wall, and 
should not be located where it can be 
obscured by hanging towels or drying 
clothes. 

• Showers and Tubs. There is contro- 
versy concerning the choice between 
programming bathtubs or showers. 
Either can be more costly, depending 
upon specific bathroom layouts, fix- 
tures, controls, finishes and accessories. 



Bathtubs are more likely to lead to falls 
than are showers, because of the need 
to step over the side and stand on a wet 
surface while off-balance. However, 
many older people enjoy baths, and 
movable seats and special tubs are 
available that can facilitate transferring 
in and out of the tub without standing 
and stepping over the side. 

Showers are recommended in congre- 
gate housing and residential care facili- 
ties, where the older user is likely to be 
more frail and have difficulty in ambu- 
lation. When showers alone are pro- 
vided in private bathrooms, bathtubs 
can be provided in common bathrooms 
for those older residents who prefer to 
bathe in a tub, or whose health care 
requires soaking. Where bathtubs are 
provided in common bathrooms, pro- 
vide at least one bathtub on each apart- 
ment floor. 

Locate controls for tubs and showers in 
positions accessible both from inside 
and outside the fixture. Provide controls 
of the single-lever mixing valve type, 
with temperature limiting controls (to 
prevent scalding), and shower heads 
that are adjustable in both height and 
intensity of water-stream pressure. 



74 III 



Bathrooms, Private 



• Water Closets. The water closet can 
present a design dilemma to the archi- 
tect and specifier: A seat height high 
enough to facilitate an older person's 
getting on and off the toilet may cut off 
blood circulation to the legs and prevent 
the user's attainment of the best posi- 
tion for moving the bowels (a full 
squat). On the other hand, a seat height 
that is too low may facilitate movement 
of the bowels but prevent the user from 
getting off the fixture. "Handicapped 
toilets" (also see ANSI A117.1 or 
applicable barrier-free design standards) 
are not recommended for general use 
by older people. 

Standard height water closets — 15 
inches to the top of the seat— are 
recommended for general use by the 
elderly, with appropriately placed grab 
bars that help in getting on and off the 
fixture. Toilet seat covers are recom- 
mended to facilitate use of the fixture as 
a seat for grooming activities. 

• Grab Bars. Grab bars should be 
included in bathrooms to provide solid 
handholds for the user entering and 
exiting the tub or shower, and getting 
on and off the toilet. The use of a grab 
bar as a towel bar or drying rack 
defeats its purpose; this common use 
cannot be prevented, but the provision 
of adequate and accessible towel bars 
and drying racks in addition to grab 
bars helps minimize it. 



In adaptable bathrooms, provide for the 
solid mounting for grab bars so that 
occupants may add them later as cir- 
cumstances and tastes require. Mate- 
rials that avoid an institutional, "stain- 
less steel" appearance should be 
considered. 

• Privacy. Locate the bathroom so that a 
door left open will not provide direct 
views into the bathroom from the entry, 
living/dining room or kitchen. 

• Safety. Provide bathrooms that are 
safe, convenient and free of sharp cor- 
ners, projections and slippery surfaces. 
Locate bathroom fixtures and equip- 
ment so that excessive bending, leaning, 
and twisting will not be necessary for 
their operation. Lay out the bathroom 
so that users need not reach across 
counters in order to access storage 
cabinets or electrical outlets. Locate 
electrical outlets adjacent to the lava- 
tory, but not above sinks or tubs where 
electrical appliances might fall into 
standing water. Protect outlets with 
ground-fault interruption devices. Tem- 
perature-limit controls should be pro- 
vided on domestic hot water in the 
bathroom to keep temperatures at the 
fixture below 115 degrees F. and pre- 
vent accidental scalding. 

• Storage. Provide bathroom storage for 
toiletries, medicine and towels. 



Ill 75 



Bedrooms, Housing 



• Toilet Accessories. Consider locating a 
mirror in front of the toilet to permit 
shaving and other grooming activities 
while the user is seated. Wall-mounted 
mirrors behind lavatories are often too 
distant for older users, requiring them 
to stand and bend over the lavatory in 
order to get close to the mirror; a mir- 
ror located on a wall that can be 
approached directly is recommended. 
Illuminate mirror areas with warm 
colors. 

Locate towel bars where they will not 
likely be used as grab bars (for exam- 
ple, four feet above the floor), but still 
within easy reach of the tub or shower 
and lavatory. Coordinate the location of 
towel bars with the location of the 
emergency call switch to minimize false 
alarms caused by grabbing for towels, 
and to prevent obstruction of the switch 
by towels or drying clothes. Anchor 
towel bars firmly so that they will break 
a fall if they are grasped in an emer- 
gency situation. 

Also see Barrier-Free Design, Central 
Bathing, Communication Systems, 
Congregate Housing, Doors, Toilet 
Rooms, Elderly Housing in Part II: 
Facility Types, and refer to barrier-free 
design standards. 



BEDROOMS, HOUSING 

In addition to sleeping and dressing in 
the bedroom, many older people also 
spend time there while pursuing their 
crafts and hobbies, reading, watching 
television and resting, and also in times 
of illness. For any user, the bedroom 
should afford privacy as well as protec- 
tion from noise and drafts. 

Furnishability is a major concern in the 
bedroom. Select room dimensions and 
location of doors and windows to allow 
alternative furniture arrangements, espe- 
cially alternative bed placements. Pro- 
vide sufficient space for two twin beds, 
side tables, dresser, chair, television and 
stand, and circulation. Locate windows 
to afford good views for the individual in 
bed, with sills low enough (15 to 20 
inches above the floor) to allow the resi- 
dent to see outside from the bed. Locate 
windows to create useful corners, so that 
furniture can be backed by walls rather 
than by windows. 

Also see Furnishability, Privacy, Tele- 
vision Viewing Areas and Elderly 
Housing in Part II: Facility Types. 



76 III 



Beds 



BEDS 

Older people spend a significant portion 
of time in bed, especially when they are 
physically incapacitated or ill. Pro- 
vide beds with sufficient width to facili- 
tate resting, sitting, sexual activity and 
getting into bed, with sufficient height to 
facilitate getting out of bed and seeing 
out of the window while in bed. 

Call systems, telephones and controls for 
lights and television should be accessible 
and controllable from the bed without 
excessive twisting, reaching or having to 
get out of bed. Injuries from falls near 
the bed can be minimized through the 
use of round-edged furniture. 

Nursing homes should provide more 
than one type of bed to accommodate 
different personal and nursing care 
requirements. The standard hospital bed 
is too narrow for general nursing home 
use. The beds manufactured by health 
care suppliers often are over 7 feet 6 
inches in length; these beds should be 
avoided or additional space should be 
provided in resident's rooms to accom- 
modate their excessive length. 

Also see Residents' Rooms and Safety. 



CENTRAL BATHING 
(NURSING HOMES) 

Most nursing home residents require 
assistance with bathing that is usually 
accomplished in a central room equipped 
with special lifts and other equipment. 
Even though most nursing home resi- 
dents must give up their personal control 
of bathing to staff, the bathing room 
should bear some resemblance to a resi- 
dential bathroom. Provide a central 
bathroom design that maintains a rela- 
tionship to previous bathing experiences, 
as well as privacy while bathing, drying 
and dressing. Avoid the portentous 
appearance of a surgical suite. General 
design recommendations are: 

• Provide individual rooms or enclosures 
for privacy. 

• Provide space for bathing, drying, 
dressing, assistance, wheelchair use and 
wheelchair parking. 

• Provide temporary storage for personal 
bathing and grooming items, as well as 
clothing. 

• Provide doors with the 34 inches clear 
opening required for wheelchair access 
(see ANSI A117.1 or applicable barrier- 
free design standards) as well as hard- 
ware that permits access from the out- 
side in case of emergency. 

• Provide floors with nonslip surfaces. 



Ill 77 



Central Bathing 



Provide walls with washable finishes 
and, in fixture areas, moisture resis- 
tance. 

Provide a minimum ceiling height of 7 
feet 8 inches with cleanable surfaces. 
Provide adequate light levels and highly 
contrasting colors for changes in plane. 
Control reflections and glare. 
Provide grab bars at all patient toilets, 
showers, tubs and sitz baths (see ANSI 
A117.1 or applicable barrier- free design 
standards). 



• Provide recessed soap dishes in showers 
and bath. 

Also see Bathrooms-Private, Toilet 
Rooms, Nursing Homes in Part II: 
Facility Types, and refer to barrier- free 
design standards. 



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Central Bathing Areas should allow sufficient space for bathing activities, special equipment, 
wheelchair maneuvering, and attendants. 



78 III 



Communication Systems 



COMMUNICATION SYSTEMS 

Alarm Systems. Special attention must 
be given to the design of any alarm sys- 
tem intended to warn older people of 
emergencies. The key is to both commu- 
nicate the appropriate information about 
the emergency and stimulate an appro- 
priate response. 

Many older people have visual and/or 
hearing impairments. Thus, redundant 
cueing, such as providing signals that 
can be seen as well as heard, is essential 
in the design of alarm signaling systems 
for older users. 

In addition, the architect should consider 
the action that an alarm signal is 
intended to initiate. Often the typical 
response of a building occupant who 
hears or sees a fire alarm signal is to 
leave the building; there are many situa- 
tions, however, in which older residents 
may risk greater injury by trying to 
evacuate than by seeking refuge and 
awaiting assistance. 

Specific emergency responses for older 
persons must be developed for specific 
buildings, and different alarm signals 
should be designed for different 
responses. For example, a "less alarm- 
ing" tone-and light combination might 
be used to signal an older person to close 
doors and wait for assistance, while a 
"more alarming" signal combination 
would dictate evacuation. 



Call Systems. Should sickness, accident 
or another contingency render an elderly 
person helpless in his or her unit, a call 
system can alert others of the need for 
assistance. Call systems range from sim- 
ple monitoring devices — "flags" on 
mailboxes that are turned each day to 
indicate that one is up and about, for 
example — to small radio transmitters 
carried or worn by the older person at 
all times. 

The call system might sound an alarm in 
a central staff facility (manager's office 
or apartment, lobby switchboard or 
nursing station), be linked to a fire 
alarm voice-communication system or 
activate a hallway light outside the unit. 
To avoid panic, buzzers indicating that 
the call system has been activated should 
not be used in public areas. 

Telephone-based call systems can pro- 
vide two-way communication if 24-hour 
staffing is not provided. Consider tele- 
phones that will ring a preset series of 
phone numbers — say, for a neighbor and 
a family member or staff member — if a 
button is not pushed before a preset time 
each day, as well as those with wireless 
"slaves" that will ring the same set of 
numbers if a button is pushed in an 
emergency. 



Ill 79 



Communication Systems 



For fixed-station call systems, two alarm 
stations should be provided — one in the 
bathroom, reachable from the shower, 
toilet and floor, and one in the bedroom, 
reachable from the bed. Locate each call 
station 30 to 36 inches above the floor 
and attach to its switch a wood or plastic 
rod that can be reached from the floor. 
Locate call systems where they will not 
be activated accidentally. If provision of 
only one call station is feasible, locate it 
in the bathroom. 

Newer technologies in personal call sys- 
tems are also available. For example, a 
resident can wear a necklace or "pen" 
with a small transmitter inside; if an 
emergency arises, he or she can activate 
the transmitter, sending a signal to a 
central monitoring unit. These systems 
are now in communitywide use in some 
areas, and are much more flexible than 
building-dependent systems. 

In nursing homes, more sophisticated 
nurse-call, medical monitoring, tele- 
metry, beeper and remote diagnostic sys- 
tems may be required. 

Telephones. The telephone is a major 
medium of communication for most 
older people, and it should always be 
accessible and usable. Private telephones 
should be located near the bed, in the 
bathroom and in the kitchen in residen- 
tial settings. 

Placement of telephones in nursing 
homes should be similar, but will depend 
upon the administrative and accounting 



practices of the facility. Telephone 
charges, for example, may not be reim- 
bursed by governmental or third-party 
payers. Thus, facilities may choose to 
furnish phones (so they maintain the 
integrity and use of intercom and nurse 
paging/call systems) and charge each 
resident for them separately, or they 
may choose to make residents' phones 
optional equipment, to be furnished and 
maintained by the resident. The archi- 
tect should review the client's intent 
before preparing the pertinent construc- 
tion documents and specifications. 

Public telephones should be located near 
waiting and activity areas. Places to sit 
comfortably while talking should be pro- 
vided, as should the lighting needed for 
looking up telephone numbers and dial- 
ing. See ANSI A117.1 or the applicable 
barrier-free design standards for mount- 
ing height and wheelchair clearance 
requirements. 

Among the large variety of telephone 
instruments on the market today, those 
with familiar touch-tone dialing and 
amplifiers for the hearing-impaired are 
generally most useful to older people. 
Telephones that offer one-button dialing 
for emergency and frequently used num- 
bers are also popular and appropriate. 

Also see Barrier-Free Design, Bath- 
rooms, Lighting, Nursing Station, 
Redundant Cueing, Nursing Homes in 
Part II: Facility Types, and refer to 
barrier- free design standards. 



80 III 



Community Spaces 




Michael R. Koury Terrace 
Torrington, Connecticut 

Ulrich Franzen & Associates, Architects 



COMMUNITY SPACES 

Community spaces, such as activity 
areas, corridor alcoves and lounges pro- 
vide the primary forum for social inter- 
action among nursing home residents. 
Community spaces must be designed to 
facilitate such interaction without com- 
promising the residents' privacy 
requirements. 



In community spaces, provide furniture 
and furnishings that are residential in 
nature, rather than institutional, to 
establish a link with the residents' previ- 
ous living environments. 

Provide direct access from community 
spaces to primary circulation paths, and 



Ill 81 



Congregate Housing 



indirect access to administrative offices. 
Provide access to residential zones with- 
out forcing residents to pass through 
community spaces, so that they can 
come and go without being under con- 
stant surveillance. Locate building 
entries convenient both to outside activi- 
ties and to service areas, with good vis- 
ual control. 

Residents can be given the opportunity 
to participate in community activities 
(and the choice not to) by allowing them 
to see into the space before committing 
themselves to enter and by locating the 
community space near mailboxes, the 
laundry room and other high-traffic 
areas. Connecting areas that link differ- 
ent community spaces can also be used 
as separate community spaces in them- 
selves, offering alternative levels of 
privacy and noise. 

The space requirement for community 
areas generally is 35 square feet per unit 
or, with more than 200 units, 30 square 
feet per unit. 

Also see Activity Rooms and Space 
Hierarchy. 

CONGREGATE HOUSING 

Congregate housing is elderly housing in 
which ancillary services are also pro- 
vided. A congregate meal service (for 
people who choose not to cook for them- 



selves or who prefer not to eat alone) is 
usually the nucleus of a service package 
that may also include housekeeping ser- 
vices and organized group activities. 

Also termed "service-supported" hous- 
ing, congregate housing is designed to 
keep residents' life styles as independent 
as possible for as long as possible. This 
goal has both a social and an economic 
aspect. The social goal is to sustain a 
higher quality of life; the economic goal 
is to provide a less costly alternative to a 
nursing home, as long as the full level of 
nursing home services is not needed. 
Frequently, congregate housing is one of 
several options provided in a continuing 
care retirement community. 

Congregate housing — both highrise and 
lowrise — is designed to allow efficient, 
protected access to services and to 
encourage participation in community 
social activities. Individual living units 
include bathrooms, may offer more than 
a single bedroom and generally include a 
minimal kitchen. 

Also see Bathrooms; Emergency Care; 
Housekeeping, and Continuing Care 
Retirement Communities in Part II: 
Facility Types. 



82 III 



Consultation Room 



CONSULTATION ROOM 

Consultation rooms are often provided 
in elderly housing and senior centers for 
use by residents and visiting health care 
professionals. Doctors and nurses come 
to these facilities to screen for particular 
diseases and disabilities, and to consult 
individually with residents or members 
regarding health concerns. 

Consultation rooms require space for the 
storage or permanent placement of 
examining equipment, including an 
examination table, desk, chair and side- 
chair, and supply cabinet. A multipur- 
pose room can be used if health consul- 
tations are infrequent, and if equipment 
storage is provided. The consultation 
room should be located near a lounge or 



SCALE 



EXAM 



CO 




BLOOD PRESSURE 



waiting area in which patients can sit 
comfortably while awaiting service. 

Also see Emergency Care, Examina- 
tion and Treatment Room, Nursing 
Care and Senior Centers in Part II: 
Facility Types. 

CONTINUUM OF CARE 

The goal of long-term care is to main- 
tain or improve an elderly individual's 
ability to function as independently as 
possible. The complete range of long- 
term care services available to older peo- 
ple comprises many different services, 
usually delivered by a large number of 
different service agencies, care-givers and 
private organizations. This diversity of 
long-term care services and multiplicity 
of providers can make it very difficult for 
an older individual to obtain the services 
required to meet changing needs. 

The continuum-of-care concept addresses 
this problem over the entire time span 
that support and services are required, 
and it pays particular attention to facili- 
tating the transitions between levels and 
degrees of care. The continuum of care 
can be provided through coordination of 
local services by area agencies on aging 
or other local agencies, and by continu- 
ing care retirement communities. 

Also see Long-Term Care, and Contin- 
uum of Care, Residential Care and 
Continuing Care Retirement Commu- 
nities in Part II: Facility Types. 



Consultation Room provides space for 
examinations and individual consultation. 



Ill 83 



Corridors 



CONTROL 

A sense of control over one's surround- 
ings, activities and relationships is 
important to people of all ages. Because 
of a propensity for physical impairment, 
and the losses of health, friends and fam- 
ily, many elderly persons find it difficult 
to achieve a sense of control. 

The built environment can help maxi- 
mize the control older people feel they 
have over their surroundings by mini- 
mizing dependency and the sense of 
helplessness. Two major areas of 
environmental control can be addressed 
by the architect: the ability to operate 
and use the built environment, and the 
ability to control interactions with others. 

Ensuring an elderly user's ability to 
operate and use the built environment is 
based on the same principle as barrier- 
free design. Building equipment that is 
normally under occupant control in 
buildings designed for younger people 
should also be under occupant control in 
buildings designed for the aging. Envi- 
ronmental controls for HVAC equip- 
ment, as well as windows, lights, draper- 
ies and blinds, should all be usable by 
the older occupant. 

Equipment controls that are habitually 
manipulated by elderly users in an ineffi- 
cient or dangerous manner can be over- 
ridden by the facility management as 
necessary. The architect, however, 
should not approach the design and spe- 
cification of equipment controls with the 
attitude that older people are not compe- 
tent to control their own environments. 



The user's ability to control interactions 
with others can be facilitated by the 
architect through the creation of a space 
hierarchy and provision of appropriate 
security locks and hardware such as view 
ports in doors. 

Also see Barrier-Free Design, Doors, 
HVAC, Security (for "control" in 
terms of the monitored and/or regulated 
passage of residents, visitors and others 
into or through a facility), Space 
Hierarchy, Windows, and refer to 
barrier-free design standards. 

CORRIDORS 

In buildings designed for older people, 
corridors serve a variety of functions 
beyond providing access and egress to 
various building spaces. Corridors are 
used for meeting other people, for dis- 
playing personal items, for identifying 
rooms and spaces and for other activities 
as well. 

Avoid repetitious, disorienting corridor 
designs with uniformly spaced doors and 
light fixtures. Provide corridors with a 
residential character and scale, and with 
lengths limited to 75 feet. Break up long 
corridors by changing direction, recess- 
ing doorways and varying color, texture, 
lighting and ceiling heights. Repetitious 
corridor patterns can make one corridor 
indistinguishable from another; windows, 
planters and other distinctive features 
can serve as important location markers 
for easily disoriented users. 

One of the most significant aspects of 
corridor design is the treatment of light- 
ing. Plan for the use of indirect lighting, 



84 III 



Corridors 



and a careful selection of light quality. 
Color-coding corridors to promote ease 
of identification is advisable, as is cor- 
ridor numbering. Avoid windows across 
the ends of corridors, to reduce glare 
and reflection. Daylighting, views and 
orientation can all be accomplished by 
sidelighting the ends of corridors with 
windows; this may be especially helpful 
where corridors are offset or change 
direction and/or width to accommodate 
elevation, stairs or common rooms. 



In all facilities designed for older people, 
design corridor handrails in accordance 
with the limited ranges of movement, 
low energy levels and losses of hand-grip 
strength that can characterize the 
elderly. Provide handrails on both sides 
of corridors so that older people with 
impairments in one hand or arm can 
still utilize a handrail to negotiate the 
corridor. A mounting height of 33 to 36 
inches from the floor to the top of the 
handrail is recommended. Provide cor- 




Corridors are social areas which should help to establish a spatial hierarchy. 



Ill 85 



Dining Areas 




Maple Knoll Village 
Springdale, Ohio 

The Gruzen Partnership 
New York 



ridors at least five feet wide in residential 
facilities, and usually eight feet wide in 
nursing homes, with handrails on each 
side (handrails may project into corri- 
dors). Take care to avoid an institutional 
appearance when designing or specifying 
corridor handrails. 

Remember, however, that corridors also 
serve as the principal means of egress in 
case of fire. Corridor walls, doors, hard- 
ware, ceilings, finishes and openings 
must therefore be selected to protect 
against fire and smoke as required by 
applicable codes. 



Also see Activity Areas, Alcoves, 
Doors, Exits, Handrails, Lighting, 
Wayfinding and Windows. 

DINING AREAS 

Meals are often the most formal events 
of an elderly person's day. For some, 
they are also eagerly anticipated high- 
lights of the day. Design dining areas 
with restaurantlike or homelike, rather 
than institutional, atmospheres. Provide 
table service whenever possible, as many 
older persons find it difficult or impossi- 
ble to carry the food trays required by 
cafeteria service. 



86 III 



Dining Areas 



Dining can take place in a single room 
or several smaller rooms. If a single 
multipurpose room is used for dining, 
provide adequate storage for tables and 
chairs. 

Two- and four-place tables help easily 
distracted people concentrate on table 
conversation; they also facilitate conver- 
sation through the reading of lips and 
expressions. Provide a variety of table 
sizes and shapes to accommodate differ- 
ent and changing needs. 



Space requirements for dining areas can 
be difficult to determine. The wheel- 
chairs, walkers and other ambulation 
aids used by many elderly people require 
more than the standard circulation 
spaces. Yet not all elderly facility resi- 
dents may dine in the dining area; in 
some nursing homes, as many as half of 
the residents eat in their rooms. In most 
cases, 20 square feet per dining seat pro- 
vides adequate maneuvering room and a 
margin for error in estimating the num- 
ber of diners. Meals can be served in 




Duncaster Life Care Center 
Bloomfield, Connecticut 

Stecker LeBau Arneill McManus Architects, Inc. 
Hartford, Conn. 

Maris/Semel New York, Photographer 



Ill 87 



Doors 





Doors— Entry doors to dwelling units should reinforce the sense of personalization and privacy. 



two sittings, if necessary. Depending 
upon the philosophy and program of the 
particular nursing home, mentally 
impaired residents may take their meals 
with other residents, or may eat at a dif- 
ferent time or in a separate space (for 
example, in the residents' rooms or in 
lounges). 

Space with seating for waiting prior to 
meals may be required. If so, locate the 
dining area near a lounge, and near 
public toilet rooms. 



Also see Assembly Areas, Finishes, 
Kitchens, Lounges, Outdoor Access, 
Residents' Rooms, Seating and Toilet 
Rooms. 

DOORS 

All doors should have minimum clear 
openings of 32 inches, which means 
standard door bucks should be 34 inches 
wide, to provide 32 inches clear when 
the door stands open at 90 degrees 
(unless throw-clear hinges are used to 
reduce the required door buck opening). 



88 III 



Doors 



Larger clear openings may be required 
by applicable standards and building 
codes for the primary building entrance, 
dwelling unit doors and nursing home 
resident's room doors. Dwelling unit 
doors should have security features and 
fire and smoke ratings as required by 
code. 

Bathroom doors are a concern because 
an ill or injured person lying on a bath- 
room floor may block a door that opens 
inward. Use doors that open outward or 
inward-opening doors with two-way 
jambs and hinges for emergencies. Use 
bathroom door locks that can be unlocked 
from the outside in emergencies. 

Thresholds should be flush with the 
door. Doors should require no more 
than five pounds of pressure to open. 
Revolving doors should be avoided. 

View windows should be placed in doors 
or adjacent side lights across corridors so 
as to comply with applicable codes and 
reveal a resident approaching the other 
side of the door in a wheelchair. 

Also see Architectural Hardware, Bar- 
rier Free Design; Bathrooms; Central 
Bathing; Control; Entries; Residents' 
Rooms; Sign Systems; and refer to bar- 
rier-free design standards. 



ELEVATORS 

Provide handrails in elevator cabs on 
three sides, 32 inches above the floor. 
Intercom systems inside elevator cabs are 
recommended. Provide controls and 
other features in conformance with 
ANSI A117.1 or the applicable barrier- 
free design standards, with particular 
attention given to the perceptibility of 
signs and signals, and to the timing of 
signals and automatic doors. Many older 
people require additional time to realize 
a cab is arriving, decide in which direc- 
tion it is going, find which elevator shaft 
the cab is in, stand up, gather belong- 
ings, move to the door, enter, find the 
control panel and select a floor — all 
before the door closes. 

Provide at least one elevator with a min- 
imum cab size of 67 inches to accommo- 
date stretchers and large furniture. 
Despite users' knowledge of the inevit- 
ability of illness and death, it is still very 
disturbing to see friends and neighbors 
taken out on stretchers; provide this ele- 
vator cab, therefore, with a separate 
service level or with rear doors, so that 
stretchers and gurneys (as well as furni- 
ture) need not be moved through the 
main entry. 

Provide an elevator lobby with a bench 
and table on each floor, so that residents 
may rest and put down packages. 



Also see Barrier-free design and refer to 
barrier- free design standards. 



Ill 89 



Entries 



EMERGENCY CARE 

Elderly residents of congregate housing 
and other residential facilities frequently 
need first aid or observation after acci- 
dents, falls, strokes, or episodes of ill- 
ness, pending their transfer to a nursing 
home or acute medical care facility. An 
emergency treatment room (which can 
also be used as a consultation room 
and/or examination and treatment room) 
may be provided to stabilize and hold a 
resident awaiting transfer to another 
facility. Depending on the nature of the 
facility and its anticipated resident pro- 
file, such a room might be equipped as 
an exam and treatment room, except 
that it should also provide a hospital 
bed, toilet, oxygen, good lighting 
(patient examination light) and electrical 
power for the possible use of respirators, 
defibrilators or other life-saving emer- 
gency equipment. 

Also see Congregate Housing, and 
Nursing Home in Part II: Facility 
Types. 

ENTRIES 

A building's main lobby or front porch 
can be an important community space, 
particularly in a facility where the com- 
ings and goings of residents and visitors 
can be watched. However, some resi- 
dents prefer to be able to come and go 
without the constant surveillance that 
occurs at the main entry. Consider a 
secondary entrance for building residents 
that does not include space for the 
"watchers." 



\l 


\9 


Hf 




J — i— i ■- i-,— L. 


mm Hill 




.. 



Michael R. Koury Terrace 
Torrington, Connecticut 

Ulrich Franzen & Associates, Architects 



Building Entries. Protect building 
entries from precipitation with canopies 
or building projections. Design signs and 
other visual cues in the entry and lobby 
to facilitate wayfinding. The entry should 
be convenient to vehicular pick-up and 
drop-off points and, if possible, to a 
public transit stop. Utilize a vestibule 
to keep cold air out of the main lobby 
and to protect people waiting inside from 
drafts. The building entry also is a key 
element in any security system, provid- 
ing both a location for security guards 
and/or concierge and a common location 
for a security office, including closed- 
circuit entrances and parking lots. 

Dwelling Unit Entries. Locate dwelling 
unit entries with convenient physical 
access both to the unit and to a point of 



90 III 



Entries 




CANOPY ABOVE 



a 



a 



Building Entries play a crucial role in the functional success and quality of life which an aging 
facility affords. 



Ill 91 



Entries 




Lafayette Place 

Fall River, Massachusetts 

Boston Architectural Team, Inc. 

Hresko Associates, Boston 
Phillip Hresko, Principal 
David Clark, Job Captain 

Nick Wheeler, Photographer 



transition between public and private 
areas. Consider providing an alcove in 
the corridor outside the unit with space 
for a small table or shelf on which the 
resident can place packages while open- 
ing the door. Provide entry area lighting 
that adequately illuminates the door key- 



hole. If all the dwelling unit entries 
along a corridor look alike, consider 
using nonuniform hallway furnishings as 
place markers, or allowing residents to 
decorate their doors. Provide a security 
peephole in the entry door 56 inches 
above the floor. 



92 III 



Entries 



Provide the dwelling unit entry vestibule 
with a coat closet and enough space in 
which to greet visitors and put on hats 
and coats. Design this area so that visi- 
tors at the front door cannot view the 
more private spaces of the unit. 

Service Entries. Facilities designed for 
older users usually include service entries 
that are separate from main entries, so 
that service circulation will not interfere 
with the circulation of primary building 
users. Service and delivery activities can 
be of great interest to older people and 
they provide another lively connection to 
the broader world. When planning 
entries and circulation, consider pro- 
viding for some delivery and service cir- 
culation through the front door. When a 
separate service entry is necessary, con- 
sider an activity area or lounge overlook- 
ing this (traditionally screened) area. 

Also see Control, Corridors, Doors, 
Lobby/Reception Areas, and Site 
Development. 

EXAMINATION AND 
TREATMENT ROOM 

The nursing home examination and 
treatment room is the area within a 
nursing unit where medical care that 
cannot be given at the resident's bedside 
can be provided. State codes and regula- 
tions usually require the provision of 
particular items of furniture and equip- 
ment in the examination and treatment 
room, which should be located close to 
the nursing station for easy access by the 



nursing staff. Visiting medical personnel 
may also use the examination and treat- 
ment room, so it should be located near 
a lounge or alcove where residents can 
wait comfortably and interact with 
others. 

Also see Consultation Room, Nursing 
Care, and Nursing Homes in Part II: 
Facility Types. 

EXERCISE AREAS 

Exercise areas in elderly housing can be 
underutilized if they are placed in an iso- 
lated location within the facility and fur- 
nished with unfamiliar, medical-looking 
equipment. Design exercise rooms and 
equipment with a recreational, rather 
than therapeutic, appearance. Commer- 
cial health spas provide a good example 
of exercise areas that are stimulating and 
social, rather than depressing and lonely. 
Provide carpeting (without pad) to soften 
impacts and dampen noise. Plants, mir- 
rors, warm colors, small rest areas, 
music and PA systems, and conversa- 
tional groupings of exercise equipment 
help enliven the atmosphere. 

Locate exercise rooms or areas directly 
off well-used corridors with previewing 
opportunities that will enable residents to 
see activity taking place in the room. 
Locate exercise areas in close proximity 
to other recreational facilities and activity 
areas that may be provided, such as 
swimming pool, lockers, showers, hydro- 
therapy facilities and outdoor game 
areas. 



Ill 93 



Exits 



Exercise areas often have unique heat- 
ing, ventilating and airconditioning 
requirements because of the activity tak- 
ing place in them. Whenever possible, 
locate exercise areas with a link to the 
outdoors, and avoid putting the rooms 
in a basement where they will be little 
used. 

Also see Activity Areas and Outdoor 
Spaces. 

EXITS 

Provide fire and emergency exits in 
accordance with local building codes. 
Many state codes govern the construc- 
tion of nursing homes and health-related 
facilities, but the architect must also be 
aware that many older occupants are 
unable to move quickly out of a build- 
ing, even via an accessible route (see 
ANSI A117.1 or the applicable barrier- 
free design standard), and that trying to 
do so might put them at greater risk. 
The provision of safe refuge areas within 
the building, smoke detectors and 
sprinkler systems should be carefully 
considered. 

Reference to such model codes as the 
NFPA Life Safety Code (No. 101) is 
recommended, even if not required by 
local jursidictions. In addition, the archi- 
tect should be aware that conformance 
with NFPA 101 and its related codes is 
required because nursing homes and 
other care facilities may seek reimburse- 
ment for patient care under either the 
Medicare or Medicaid provisions of the 
Social Security Act. 



The general approach taken by all of the 
model codes regarding life safety in facil- 
ities having sleeping rooms is a "defend 
in place" approach, which establishes 
the sleeping room as the first level of 
protection (with rated openings, walls, 
etc., plus smoke detectors and/or sprink- 
lers and alarms). Horizontal evacuation 
to an adjacent smoke compartment (area 
of refuge) is the second level of protec- 
tion, and vertical evacuation using stairs 
is the third. 

To succeed, this approach requires that 
low fuel and hazard levels (for combus- 
tion and smoke products) be maintained 
in the selection of interior finishes, mate- 
rials, furniture and furnishings. The 
facility must also be operated safely (with 
corridors and exits unobstructed, proper 
placement and testing of fire extinguish- 
ers, hoses, etc.). In addition, facility per- 
sonnel must be trained and residents 
well rehearsed in what to do in case of 
fire. 

Also see Safety. 



94 III 



Finishes 



FINISHES 

Conformance with the recommendations 
of a model code such as NFPA 101 is 
recommended when selecting floor fin- 
ishes, carpeting, and wall finishes such 
as vinyl wall covering and cabinetry 
made of wood or plastic laminates. 

Floors. Carpeting should be used in 
lounges, corridors and other spaces used 
by residents to provide a pleasant walk- 
ing surface and to reduce glare and 
noise. A level-loop carpet should be 
used. Use direct-glue carpet without a 
pad to avoid tripping and to reduce 
wheelchair rolling resistance. The archi- 
tect should consider the fire ratings of 
carpet and backing; many backings give 
off noxious fumes and thick smoke dur- 
ing fires, even at slow burn rates. Jute 
backing is safer, but it is also water- 
absorbent — a problem when urinary 
incontinence is common. 

Patterned, easily-cleanable carpet should 
be used in dining areas, where food 
spillage can be a problem. Water spillage 
in bathrooms discourages the use of car- 
pets there. 



Where sheet vinyl or tile flooring is 
used, the surface should be nonslip and 
nonreflective. A change in floor-finish 
type, texture or color at corridor inter- 
sections can be helpful for way finding. 

Walls. Corridor wall finishes should be 
designed to withstand high levels of traf- 
fic, including contact with wheelchairs, 
walkers and carts where necessary. 
Brick, concrete block and tile resist 
abuse, but must be smooth enough to 
avoid abrading or cutting elderly people 
as they brush against walls; rough-tex- 
tured paint should not be used for the 
same reason. On the other hand, slick 
surfaces that reflect glaring light should 
be avoided. 

Ceilings. Ceilings in residents' 
rooms — especially rooms for the bedrid- 
den — can be textured, pattern painted or 
fabric-covered to provide visual relief 
and serve as aids to orientation. 

Also see Central Bathing, Corridors, 
Residents' Rooms, and Part I: Intro- 
duction — Aging and the Environment. 



Ill 95 



Group Homes 



FURNISHABILITY 

Furnishability is the capacity to furnish a 
space or room in a variety of arrange- 
ments. Living/dining rooms, bedrooms 
and particularly residents' rooms should 
be designed so that each key piece of 
furniture can be located in more than 
one place. A fixed position for the televi- 
sion set (dictated, perhaps, by the provi- 
sion of only one antenna outlet) or the 
failure to provide space for bed or couch 
on at least two different walls may elim- 
inate the flexibility required to furnish 
spaces according to older people's needs 
and tastes. 

Also see Bedrooms, Living/Dining 
Rooms and Residents' Rooms. 

GRANNY FLATS 

A granny flat is a small, detached, self- 
sufficient dwelling unit typically erected 
on the grounds of an existing house for 
use by an older relative — thus "granny." 
As originally developed in Australia, a 
granny flat was a prefabricated unit 
owned by the local government and 
erected on the land of any citizen in 
need of accommodation for an older 
relation. 

The granny flat concept enables an older 
relative to live with a high degree of 
independence, with occasional support 



from the main household. When the 
granny flat is no longer needed for this 
specific use, local government may 
repossess the unit, thus avoiding conflict 
with zoning regulations that may pro- 
hibit such occupancy of outbuildings on 
a permanent basis. 

In the United States, granny flats are 
often referred to as ECHO (elder cottage 
housing opportunity) housing. 

Also see Accessory Apartments and Site 
Analysis. 

GROUP HOMES 

While group homes are similar to board- 
ing homes — both feature private bed- 
rooms and shared bathrooms, living 
areas and kitchens — group homes are 
operated by the members of the group, 
with household tasks and responsibilities 
assigned among the members. The 
group home concept provides a physical 
and administrative environment that 
enables older people to help each other 
live independently. Several group homes 
have been designed with this specific 
concept in mind, and with special atten- 
tion paid to the needs and interactions of 
the residents. Group homes are also 
referred to as "shared housing." 

Also see specific rooms and spaces, such 
as Kitchens. 



96 III 



Handrails 



HANDRAILS 

Provide handrails that are easy to grasp 
and free of sharp edges. Recommended 
dimensions include a minimum edge 
radius of 1/8 inch and a diameter of 1 K 
to 1 V2 inches. Mount handrails 33 to 36 
inches from the floor to the top of the 
rail. If mounted to a wall, provide al^ 
inch space between wall and handrail. 
Recessed rails should be avoided, and all 
handrails should return to the wall. 

Since many facilities for the elderly also 
require guardrails to protect walls from 
wheelchairs, carts and other wheeled 
traffic, architects have frequently 
attempted to provide a single rail to 
serve as both handrail and guardrail. 
Although such economy may seem rea- 
sonable, the architect should carefully 
consider whether the dual-purpose rail 
serves either purpose well. For example, 
to be easily grasped with a strong 
enough grip to keep an elderly person 
from falling, the handrail form must per- 




Vv 



Handrails— The two handrails above are 
acceptable designs. The third rail does not 
allow sufficient grasp and is not recom- 
mended. Handrail surfaces should be non- 
slip and all edges should have a minimum 
radius of 1 / 8 inch. 



Ill 97 



Heating, Ventilating and 

Airconditioning 




mit the fingers of the hand to encompass 
virtually the full circumference of a rail- 
ing. Integrated hand and guardrails 
must be carefully designed to serve their 
handrail function properly. 

Also see Alcoves, Barrier-Free Design, 
Corridors, Elevators, Ramps, Stairs 

and refer to barrier-free design stand- 
ards. 

HEATING, VENTILATING AND 
AIRCONDITIONING 

Heating, ventilating, and aircondition- 
ing (HVAC) systems are often designed 
to meet the conditioned-air needs of peo- 
ple who are young and active. Many 
older people are less active and more 
susceptible to respiratory ailments and 
colds than younger people, and they 
require HVAC systems designed to nar- 
rower ranges of comfort than those 
designed for the average population. 
Moreover, many elderly people are so 
susceptible to the loss of body heat that 
they risk lowered body temperature 
(hypothermia) and thus have little toler- 
ance even for transient swings in ambi- 
ent temperature throughout an entire 
facility. 



Consult local codes (or a model building 
code such as NFPA 101 and its related 
codes) for smoke exhaust, smoke and fire 
control damper, and fire and smoke zon- 
ing and control requirements. Pay 
special attention to exhaust systems, fil- 
ters and air recirculation in residents' 
rooms, particularly where odor control 
and the filtration of airborne particles 
may be of concern (in nursing homes, 
for example). 

Good design criteria include the 
following: 

• Heating and Cooling. In areas nor- 
mally occupied by older people, provide 
a design capacity for a temperature of 
75 degrees (F); in nursing homes, 
special reserve capacity requirements 
may apply (see applicable codes and 
standards). Provide each nursing home 



OUTDOOR AIR 
FROM 
CENTRAL 
SYSTEM -^ B&_ ^_ CURTAINS 




FAN COOL 
UNIT 



COLD 
AIR 



HVAC— The mixing of outdoor air from a 
central system and warm air from window 
units helps to diminish drafts. 



98 III 



Heating, Ventilating and 
Airconditioning 



resident's room with at least one ther- 
mostat. Consider providing auxiliary 
heat lamps or heaters in toilet rooms, as 
well as in elderly-housing bathrooms. 

• Ventilation. In most cases, a combina- 
tion of natural and mechanical ventila- 
tion is preferred because elderly people 
frequently experience a feeling that 
there is "insufficient air" in buildings 
with sealed windows. Provide residents 
with some control over supply and 
exhaust air. Avoid drafts, especially at 
floor level. 

In areas normally occupied by older 
people, mechanical ventilation systems 
should provide a minimum of two air 
changes of outdoor air per hour. In 
areas where odors are produced, such 
as toilet rooms and bathrooms, provide 
a minimum of 10 total air changes per 
hour (two of which are outdoor air). 
Other specific rooms and spaces may 
have different requirements. Refer to 
applicable codes and regulations. 

• Energy Conservation. Passive solar 
design techniques including daylighting, 
thermal mass storage and orientation to 
the sun can be appropriate for commu- 
nal spaces in all types of facilities. In 
units where the elderly, many of whom 
are on fixed incomes, pay utility costs 
directly, care should be paid to the 
design and maintenance of all building 
systems that use energy, including 
building mechanical equipment and 
lighting. Simple improvements such as 
weatherization (caulking and weather- 



stripping) and careful energy manage- 
ment practices are also cost-effective 
when adequate ventilation is assured. 

• Maintenance. HVAC mechanical 
breakdowns have a greater impact on 
elderly people because the elderly fre- 
quently have difficulty maintaining a 
normal body temperature. Thus, provi- 
sion of reliable equipment and of subse- 
quent preventive maintenance are high 
priorities in facilities designed for older 
people. Safety is also a concern, espe- 
cially when dwelling units contain indi- 
vidual heating/cooling units and water 
heaters. Consider all appropriate safety 
devices; and to avoid accidental burns 
all exposed heating andJiot water risers 
should be insulated. 

Also see Control. 

HOME CARE 

Home care is the delivery of long-term 
care services in the older person's own 
home. These include medical, social and 
supportive services designed to maintain 
the individual in the community and to 
compensate for impaired functions. In 
communities where home care is offered, 
most of the medical and social services 
that are typically available in nursing 
homes are also available to individuals at 
home. 



Ill 99 



Housekeeping 



Recent programs have demonstrated 
high rates of success in helping elderly 
residents who need long-term care to 
maintain quasi-independent lives at 
home, without the dependence of long- 
term occupancy in expensive nursing 
homes. For example, in a demonstration 
program designed to care for people at 
home until nursing home beds became 
available, not one home care recipient 
has entered a nursing home in the four 
years the program has been operating. 

Also see Nursing Homes in Part II: 
Facility Types. 

HOSPICE CARE 

Hospice programs provide supportive 
services for individuals with terminal ill- 
ness, and for their families. Hospice care 
focuses on the control of pain and on 
easing the personal and social aspects of 
death and dying. Families are helped to 
live out this process with dignity and 
mutual support in a noninstitutional 
setting. 

The hospice care concept has yet to 
develop its own building type, although 
facilities have been specially designed for 
this purpose. Hospice care often is pro- 
vided in hospitals, in nursing homes and 
in patients' homes. The contemporary 
hospice strives to provide care at home; 
relocation to centralized facilities is 
reserved for temporary situations or the 
last resort. Hospice services may include 
nursing care, medical and social services, 
homemaker and home health aide ser- 
vices, and counseling for both patient 
and family. 



Also see Nursing Homes in Part II: 
Facility Types. 

HOUSEKEEPING 

Levels of housekeeping service vary 
widely by facility type and building con- 
figuration. Housekeeping spaces include 
clean supply rooms and soiled utility 
rooms for waste collection on each floor, 
central supply and equipment rooms, 
pickup and delivery spaces for central 
laundry, janitorial closets and employee 
locker rooms. 

All housekeeping spaces should be 
located to avoid disruption of the resi- 
dents' daily living patterns. Central 
housekeeping areas should be oriented 
away from major exit/entry points and 
outdoor common spaces, and be grouped 
together adjacent to a service entrance. 
Provisions to avoid unauthorized access 
should be made. 

Small janitorial rooms should be locked 
and marked — for safety as well as to 
avoid confusion with living spaces. In 
highrise residential facilities, trash 
chutes should be easily accessible (See 
ANSI Al 17.1 or applicable barrier-free 
design standards) and clearly marked on 
each floor. Separate rooms for trash 
chutes are not necessary unless required 
by code, and may pose security and san- 
itation problems. Housekeeping services 
may also be provided as a support ser- 
vice to elderly residents who need such 
assistance to continue quasi-independent 
living in their own homes, congregate 
housing or group homes. 



100 III 



Housekeeping 



In nursing homes, separate clean supply 
and soiled utility rooms are often 
required by code, as are specific spaces 
for linen supply and disposal (chutes), 
waste collection and/or incinerator 
chutes, and janitorial services. 

Also see Entries, Laundry Facility, 
Residential Services and Residential 
Care in Part II: Facility Types. 

KITCHENS 

Commercial kitchens used by staff to 
prepare food for elderly people can be 
designed using the standard specifica- 
tions for institutional kitchens — depend- 
ing upon the specific food service pro- 
gram. If, for example, the food service 
program of a nursing home calls for the 
use of prepared frozen meals, a separate 
kitchen may be required on each nursing 
unit to store the frozen meals and to 
cook them in microwave ovens. Such 
floor kitchens are normally designed for 
use by staff, using institutional kitchen 
specifications, and are not often designed 
for use by the residents. 

Senior centers, nursing homes, and con- 
gregate housing facilities may serve as 
bases of operations for such meal prepar- 
ation and delivery services as "meals-on- 
wheels." If meals-on-wheels are to be 
provided, special requirements for stor- 
age and vehicle access and loading must 
figure in the design program. 



Residential kitchens in dwelling units 
should be screened from other living 
spaces, and be directly adjacent to the 
entryway to facilitate the depositing of 
packages; access to living spaces should 
not be through the kitchen. Provide 
adaptable kitchens, with clearances, con- 
trols, appliances, storage and adjustable 
counter and sink, as defined below and 
in ANSI A117.1. 

In specifying kitchen equipment, the fol- 
lowing should be considered: 

• Counter Tops. Provide at least 12 
square feet of surface area, 30 inches in 
height and adjustable or replaceable as 
a unit to provide alternative heights of 
28 inches, 32 inches and^36 inches 
measured from the floor to the top of 
the counter surface. Where space per- 
mits, provide 4 to 6 square feet at table 
height for kitchen dining (see ANSI 
A117.1 on adaptable kitchens). 

• Sinks. Provide a counter-mounted sink 
that is adjustable or replaceable as a 
unit to provide alternative heights of 28, 
32 and 36 inches, measured from the 
floor to the top of the counter surface. 
Design base cabinets with the flexibility 
to provide knee space below the sink, to 
accommodate the potential use of a 
stool or wheelchair. To avoid burns, 
insulate exposed hot water lines and 
traps (see ANSI A117.1 on adaptable 
kitchens). 



Ill 101 



Kitchens 




_s 



Kitchens— This kitchen is shown generously large to illustrate the features described. Other 
layouts are shown in Part II: Facility Types; Elderly Housing. Kitchen design should allow for 
future adaptability. 



102 III 



Kitchens 



• Shelves and Cabinets. Provide as 
much shelving as possible, 12 inches or 
deeper, 48 inches or less from the floor 
when mounted above a counter. Under- 
counter storage should be provided in 
deep drawers mounted on roller guides. 
Shallower shelving is appropriate if it is 
less than 27 inches from the floor. 
Allow at least 1 5 inches of clearance 
between the underside of the counter 
and the top of the first shelf below. 

Provide swing-type cabinet doors that 
are 15 inches or less in width. Corners 
and edges should be rounded. An addi- 
tional six-inch-deep shelf located in the 
15-to-16 inch space between the counter 
and upper cabinet can be very useful 
and convenient. 

• Cooking Range/Oven. Provide a 
counter-mounted range that is adjust- 
able or replaceable as a unit to provide 
alternative heights of 28, 30, 32 and 36 
inches, measured from the floor to the 
top of the cooking surface. Provide a 
separate, wall-mounted oven, with the 
bottom no lower than 27 inches above 
the floor. Electric stoves with front con- 
trols are recommended for safety. Pro- 
vide controls that feature contrasting 
shapes as well as sharply contrasting 
colors and large numerals. Avoid under 
counter ovens, unless they are self- 
cleaning (see ANSI A117.1 on adapt- 
able kitchens). 



• Refrigerator/Freezers. Provide a verti- 
cally divided, two-door refrigera- 
tor/freezer that allows for variable access 
and reach. If a standard one door 
model must be used, provide 50 percent 
of the freezer space and all of the refrig- 
erator space 54 inches or less above the 
floor. Avoid undercounter refrigerators; 
they are difficult to access for many 
older people and could invite falls and 
injuries (see ANSI A117.1). 

• Lighting. Provide strong overhead 
lighting, particularly over the sink and 
range, and task lighting where neces- 
sary. Daylighting is always desirable in 
a kitchen space. Provide task lighting 
for the work counter, with fixtures 
attached to the underside of the upper 
cabinet; such fixtures should have lenses 
and glare shields to protect shorter 
residents from direct glare. 

• Ventilation. If possible, provide both 
natural and mechanical ventilation, 
including exhausts. Recirculating 
fan/filter systems are not recommended. 

• Other. Provide space for wall-mounted 
cooking utensils and make allowances 
for the placement of kitchen plants. If 
possible, provide windows for a view to 
the outdoors. 



Ill 103 



Laundry Facilities 



Storage in the kitchen should always be 
designed with consideration for the phy- 
sical limitations of the elderly, many of 
whom find it difficult to reach high or to 
stoop. A good rule of thumb is to locate 
all short-term storage at heights between 
the knee and shoulder. A full-height 
pantry is desirable, as are wall cabinets, 
cupboards, drawers and a broom closet. 
Avoid cabinets over stoves. 

Also see Congregate Housing, Group 
Homes, Snack Bars and Senior 
Centers, Nursing Homes, Continuing 
Care Retirement Communities in Part 
II: Facility Types. 

LAUNDRY FACILITIES 

In much elderly housing, private 
washer/dryers often are provided in indi- 
vidual dwelling units. These 
washer/dryers are unarguably conveni- 
ent, but common laundry facilities in 
elderly housing serve the important addi- 
tional function of providing social 
gathering spaces. When designing these 
less private but more social spaces, con- 
sider providing comfortable seating that 
is adjacent to the common laundry room 
and acoustically, but not visually, separ- 
ated from the machine room. Provide 
adequate lighting, including task lighting 



for ironing and sewing areas, as well as 
reading lamps in the lounge area. Plan 
for views to the outdoors and to nearby 
toilet rooms; visual connections to adja- 
cent spaces are desirable. Also consider 
double sinks for hand washing, ironing 
boards, layout and sewing tables, and 
drying rods. 

In highrise facilities, a laundry room 
should be provided on each floor. In 
lowrise or scattered facilities, provide 
weather protection if residents must go 
outside to reach the laundry facility. 
Consider smaller, scattered laundry 
rooms rather than a centralized facility. 
Allow one washer/dryer for every 20 
dwelling units. 

Also see Activity Areas and House- 
keeping, and refer to barrier-free design 
standards. 




Laundry Facilities and their adjacent 
lounges can increase the likelihood of social 
interaction. 



104 III 



Lighting 



LIGHTING 

Although only one person in three has a 
measurable eye defect at graduation 
from college, about eight adults in ten 
have such a problem at the age of 60. 
Several age-related factors contribute to 
difficulties with seeing: 

• Visual acuity declines with increasing 
age. The level of illumination required 
to see forms, symbols and objects 
increases with advancing age. 

• The eye's ability to accommodate itself 
to seeing near objects, as well as distant 
objects declines with increasing age. 

• The amount of time required to adapt 
to changes in illumination level 
increases with advancing age. 

• Sensitivity to glare increases with 
advancing age. 

• The total visual field narrows with 
increasing age. 

• Cataracts become more common with 
increasing age. 

• Defects in color vision become more 
common with increasing age. 

The architect can help mitigate the 
effects of many of these age-related 
vision problems through careful lighting 
design. First, provide a higher level of 
illumination. The Illuminating Engineer- 
ing Society recommends that, for people 
60 years of age (who have normal vision 
for their age), about twice the level of 
illumination should be provided as 
would be required for normal 20-year- 
olds. 



However, no single level of illumination 
can be recommended; visibility depends 
more on the specific task being per- 
formed under a certain lighting condi- 
tion than the lighting itself. For example, 
reading handwriting in pencil requires 
more than twice the level of illumination 
than reading printed material. Thus, for 
people 60 years of age and using double 
the illumination level required by gram- 
mar school lighting standards, a mini- 
mum of 60 footcandles is recommended 
for reading printed matter, and 140 foot- 
candles is recommended for reading pen- 
cil writing. 

Second, control the range of brightness 
in the visual field. When aU objects 
within the cone of vision all appear 
equally bright, visual acuity increases in 
direct proportion to the quantity of light 
that falls on the viewed surface. A gen- 
eral rule of thumb is to keep the bright- 
ness of walls, furniture and other reflect- 
ing surfaces in a space within a 3-to-l 
ratio. For example, the following recom- 
mended reflectance values would provide 
the 3-to-l ratio for the tasks of writing 
on white paper or eating from white din- 
nerware (both with about 80-percent 
reflectance), and thus help reduce fatigue 
and eyestrain: 

• Ceilings. Reflectances should be as 
high as possible (70 to 90 percent) to 
bring the ceiling lightness close to the 
brightness of ceiling light fixtures. 



Ill 105 



Living/Dining Room 



• Walls. Reflectances should range from 
40 to 60 percent. 

• Floors. The floor is well within the 
range of vision of a person who is work- 
ing at a desk or table. Thus the floor 
should be relatively light (about 30 to 
50 percent reflectance). 

• Furniture. Desk and table tops should 
have light (but nonglare) finishes with a 
reflectance range of 35 to 50 percent. 
Most light wood furniture falls in this 
range. 

In all lighting schemes for the elderly, a 
special sensitivity to glare should be 
taken into account; highly reflective sur- 
faces and end-of-corridor windows 
should be avoided. Glare can be a prob- 
lem wherever sunlight enters, and the 
architect should provide screens, baffles 
and/or shades and curtains to be used as 
desired by residents. 

An increased illumination level at the 
intersection of two or more hallways can 
increase awareness of the area and also 
make signage more visible. Effective 
changes in illumination should be 
gradual, to accommodate a slower 
dark/light adaptation rate. Changes in 
planes, the intersections of walls and 
floors for example, should be marked by 
highly contrasting colors. 



In general, indirect lighting should be 
used whenever possible. It can increase 
the overall illumination level with less 
chance of inducing glare. Task lighting 
should be provided for such close work 
as arts and crafts activity, food prepara- 
tion, eating and reading. Task lighting 
fixtures that can be adjusted by the older 
user — adjusted in intensity, location and 
direction — should be provided. Wher- 
ever older residents are expected to 
change their own light bulbs, provide 
table-top or wall-mounted light fixtures 
to avoid possible falls. 

Lighting design must always accommo- 
date the eye level of wheelchair-bound as 
well as ambulatory residents. Resident 
control of illumination levels is almost 
always desirable. 

Also see Arts and Crafts Areas, Corri- 
dors, Site Development, Windows and 

specific room or space. 

LIVING/DINING ROOM 

The basic uses of the private living/din- 
ing room include reading, watching tele- 
vision, playing table games, working on 
hobbies, dining, and entertaining family, 
friends and guests — all relatively active, 
semiprivate uses. 

Furnishability is a major concern in the 
living space. Room dimensions, doors 
and windows should allow alternative 
furniture arrangements, and particularly 
alternative television placements (see 
Television Viewing Areas). Sufficient 



106 III 



Living/Dining Room 



space should be provided for a broad 
range of furniture types and styles; many 
older people move into elderly facilities 
from larger, older houses where they 
have accumulated many items of furni- 
ture — furniture that has special signifi- 
cance to them and may tend to be full or 
oversized. 

Windows should afford good views from 
chairs and couches. Consider locating 
windows away from room corners so 
that chairs can be placed in spaces backed 
by walls rather than by windows. Cul- 
de-sac living rooms offer more space for 
furniture than walk-through living 
rooms, that require extra circulation 
space at doorways. Balconies can supply 
good outdoor access. 

Also see Balconies, Furnishability, 
Outdoor Access, Television Viewing 
Areas, Windows and Elderly Housing 
in Part II: Facility Types. 

LOBBY/RECEPTION AREAS 

The lobby or reception area in a facility 
designed for older residents is an area of 
great interest to those residents; it's a 
connection to the outside world (see 
Outdoor Access) and a center of high 
activity. Elderly people often congregate 
to monitor all the comings and goings 
there, just as they might on the tradi- 
tional front porch with rocking chairs 
overlooking the passing scene. Alcoves or 
lounges located near the lobby or recep- 
tion area provide places from which to 
watch the hubbub without being directiy 
in the path of circulation. Public toilet 
rooms, telephones and drinking foun- 
tains should be located nearby. 



Also see Alcoves, Communication Sys- 
tems. Entries, Lounges, Mail and 
Package Delivery, Outdoor Access, 
Sign Systems and Toilet Rooms. 

LONG-TERM CARE 

Long-term care includes the range of 
services, provided continuously or inter- 
mittently, that address the health, social 
and personal care needs of individuals 
who have lost the capacity for self-care. 

Functional status, rather than diagnosis 
of disease, is the important factor in 
determining an individual's need for 
long-term care. About seven percent of 
the U.S. population between 65 and 74 
years of age, and more than 40 percent 
of those over 85 , have functional impair- 
ments that indicate a need for long-term 
care. 

Also see Continuum of Care, Home 
Care, Nursing Care, and Nursing 
Homes and Continuing Care Retire- 
ment Communities in Part II: Facility 
Types. 

LOUNGES 

In facilities designed for older people, the 
lounge is a focal point for informal activ- 
ities and casual social encounters involv- 
ing small groups. Lounges — sometimes 
known as day rooms in nursing homes — 
should be adaptable to a wide range of 
uses, from individual television viewing 
to card games, parties and other enter- 
tainments. Corners and alcoves can 
serve as minilounges in which people can 
either be alone or pursue private conver- 
sations. When space permits, creation of 
two or more lounges with different atmo- 
spheres, but in close proximity to each 



Ill 107 



Lounges 




Duncaster Life Care Center 
Bloomfield, Connecticut 

Stecker LeBau Arneill McManus Architects, Inc. 
Hartford, Conn. 

Maris/Semel New York, Photographer 



other, is recommended. Furniture clus- 
ters that can be rearranged allow an 
extra dimension of flexibility. Movable 
chairs are more acceptable than built-in, 
fixed elements, since many older people 
like to adjust chair locations to control 
their seating arrangements. 



Television can become a dominating ele- 
ment in a lounge because of the space 
taken up by the viewing area and the 
dissonance that TV sound juxtaposed 
with other activities can create (see 
Sound Control). Whenever possible, the 
television should be located in a mini- 



108 III 



Lounges 



lounge that is acoustically isolated from 
other activity spaces (see Television 
Viewing Areas). 

It is important that toilet rooms be easily 
and quickly accessible from lounge 
spaces. 



A nursing home lounge can house a 
variety of activities, including group pro- 
grams and, more commonly, casual 
encounters or card playing in small 
groups, visiting or watching television. 
The lounge serves as a social center and 
should be near points of high activity. 




Lafayette Place 

Fall River, Massachusetts 

Boston Architectural Team, Inc. 

Hresko Associates, Boston 
Phillip Hresko, Principal 
David Clark, Job Captain 

Nick Wheeler, Photographer 



Ill 109 



Medication Room 



Lounges should be open and inviting, 
and should provide good views of the 
social goings-on. 

The location of the lounge or day room 
in a nursing unit can be critical to its 
success. Locating the lounge at the end 
of a long circulation path, where it will 
be "out of the action," will probably 
cause residents to abandon it, no matter 
how pleasant its outlook or environment, 
in favor of congested hallways located in 
the thick of things. 

The corridor is often a natural lounge 
space in a nursing home. Many older 
residents enjoy sitting on the "front 
porch" just outside their residence room 
doors, where they can enjoy the activity 
of the corridor while keeping an eye on 
the personal possessions in their rooms 
(see Space Hierarchy). The provision of 
alcoves in corridors facilitates this activ- 
ity and minimizes the disruption of cor- 
ridor circulation (see Corridors). 

Also see Activity Areas, Alcoves, 
Assembly Areas, Consultation Room, 
Corridors, Dining Areas, Finishes, 
Lobby/Reception Area, Nursing Sta- 
tion, Outdoor Access, Sound Control, 
Space Hierarchy, Television Viewing 
Areas, Toilet Rooms, and Nursing 
Homes in Part II: Facility Types. 

MAIL AND PACKAGE DELIVERY 

Provide resident mail and package facili- 
ties in conformance with U.S. Postal 
Service requirements. Make the facilities 
convenient to both horizontal and verti- 
cal resident circulation. The "post 



office" space should have a residential 
quality. Combination mailbox locks are 
not recommended; some elderly people 
may have difficulty remembering combi- 
nations or manipulating dials. If 
economically feasible, design mailboxes 
to be opened by dwelling-unit keys. Pro- 
vide a secure system for handling large 
packages. Facilities for the insertion of 
mail in boxes from the rear is preferred, 
so that the mailperson can perform his 
or her work without constant surveil- 
lance by (and questions from) the 
residents. Mailrooms should have shelves 
where residents can place packages while 
accessing their mailboxes. 

Also see Lobby/Reception Areas. 

MEDICATION ROOM 

The medication room is a component of 
the nursing unit in a nursing home. It 
should not be accessible to the residents 
and should be secure from unauthorized 
entry. Special equipment is generally 
required for the storage, preparation and 
dispensing of medications by the nursing 
staff. Many state and local codes contain 
specific requirements for medication 
rooms, especially in regard to the storage 
of drugs and narcotics. Sometimes a 
medication station (work area, sink and 
storage) can be incorporated into the 
design of the nursing station and/or its 
equipment, without dedicating an entire 
room to this function. 

Also see Nursing Homes in Part II: 
Facility Types. 



110 III 



Mobile Homes 



MOBILE HOMES 

Significant numbers of older Americans 
live in mobile homes and "manufactured 
housing." Although most standard 
mobile-home models are inaccessible to 
the handicapped and may be difficult to 
use and maintain by some people, new 
and accessible manufactured houses are 
becoming available. Many of these 
newer units are being sited in mobile 
home parks designed specifically for 
older residents. Manufactured houses are 
also being promoted for use as granny 
flats. 
Also see Granny Flats. 



MULTIPURPOSE ROOMS 

Multipurpose rooms are spaces designed 
to facilitate several activities, each of 
which may carry different area furniture, 
equipment and lighting requirements. 
Multipurpose rooms appear in facility 
programs for older people because the 
elderly's anticipated activities do not jus- 
tify expenditures for separate rooms. 
The design of this space should always 
be evaluated on a life-cycle cost basis, 
however, because the personnel costs of 
making and breaking arrangements of 
partitions and furniture, plus the cost of 
the systems and the storage facilities 




Lafayette Place 

Fall River, Massachusetts 

Boston Architectural Team, Inc. 



Hresko Associates, Boston 
Phillip Hresko, Principal 
David Clark, Job Captain 

Nick Wheeler, Photographer 



Ill 111 



Nourishment Station 



required for them, may outweigh the 
cost of separate facilities having lower 
utilization rates. 

The most important feature of a multi- 
purpose room is the ease and rapidity 
with which it can be transformed from 
one activity format to another. This 
feature requires generous and convenient 
storage for furniture and equipment, as 
well as good control of light and sound. 

The versatility of the space can be 
increased with a system of sound-proofed 
partitions that create two or more 
smaller spaces. Good, effective partitions 
are expensive, but less costly installations 
may be wasteful since they may defeat 
the ability to use the subdivided spaces 
simultaneously. Provide a separate 
entrance and flexible lighting for each 
subdivision. Avoid floor tracks that 
might trip older users, some of whom 
may have a shuffling gait. Motor-oper- 
ated partitions enable users to rearrange 
their own spaces. 

Provide an accessible area easily adapted 
for performing arts, such as dance, 
theater and music. Consider arrange- 
ments of spaces that can be used for 
dressing and staging, as well as secure 
storage space for costumes, props and 
instruments. Also provide for the projec- 
tion of films by including floor outlets, 
storage for audiovisual equipment and a 
projection surface. 

A multipurpose room often becomes the 
center of activity in a senior center or 
community center. Provide sufficient 
space to accommodate the largest group 
of people expected in the facility (but not 
necessarily all the tenants or members). 



Locate the multipurpose room promi- 
nently, near the lobby and the main 
lounge and adjacent to the kitchen. 

If the room's capacity qualifies it as a 
place of public assembly, per the appli- 
cable codes, provide the necessary means 
of egress, emergency lighting, fire and 
smoke alarm and extinguishment sys- 
tems. If the cost of such systems seems 
excessive, consider whether dedicated 
low-utilization space might be preferable 
to the multipurpose room. 

Also see Activity Areas, Assembly 
Areas, and Senior Centers in Part II: 
Facility Types. 

NOURISHMENT STATION 

The nourishment station, a component 
of the nursing unit, is for the prepara- 
tion of food, drinks and snacks for the 
residents by the nursing staff. Counter 
space, storage cabinets, a double sink 
and a refrigerator are required to serve 
these functions. Complete, prefabricated 
units are available for this purpose; most 
are efficient and compact, and less costly 
than the separate purchase and installa- 
tion of the various components would 
be. Note that portable food- and drink- 
heating appliances will be used on the 
counter and may often remain there per- 
manently, leaving little work space. 

In many situations, the nourishment sta- 
tion is not open for use by residents. 
When this is the case, a separate kitchen 
can be provided for residents who enjoy 
exercising their cooking skills. 

Also see Kitchens and Nursing Homes 
in Part II: Facility Types. 



112 III 



Nursing Care 



NURSING CARE 

Nursing care is a component of long- 
term care, as are personal care and 
social services. Nursing care is provided 
under the supervision of licensed person- 
nel in a variety of facilities, ranging from 
residential settings (see Home Care) to 
nursing homes. 

In a nursing home, the nursing unit is 
where both nursing care and personal 
care services are provided. Although 
nursing care services are provided 
throughout the nursing unit, certain 
aspects of nursing care require special 
areas or rooms in the nursing unit, 
including an examination and treatment 
room, a medication room, a nursing sta- 
tion and therapy rooms. 

Also see Consultation Room, Examina- 
tion and Treatment Room, Home 
Care, Long-Term Care, Medication 
Room, Nursing Unit, Nursing Station, 
Personal Care, Social Services, Ther- 
apy Rooms and Nursing Homes in 
Part II: Facility Types. 

NURSING STATION 

The nursing station is the communica- 
tion and control center of the nursing 
unit. Nursing care staff use the station to 
monitor call and alarm systems (see 
Communication Systems), to update 
records and care orders, and often to 
observe and/or interact with residents. 
Medical staff may also use a distinct part 
of the nurses' station to work on charts, 
medication orders or medical records. 



In a teaching facility, medical residents, 
interns and students (or nursing stu- 
dents) may also require a separate chart- 
ing area for their work. Increasingly, 
charts, orders and medical records are 
becoming computerized, so counters 
must be designed to accommodate 
CRTs for clerical and medical functions. 
However, most institutions still retain 
paper routines, so work counters must 
be designed to accommodate the require- 
ments of the specific institution's manual 
and automated systems. 

Nursing care staff in a nursing home can 
find it difficult to function effectively if 
residents constantly congregate around 
the nursing station, seeking attention. If 
residents are provided with comfortable 
alcoves near but distinctly separate from 
the nursing station, they can watch the 
activity that takes place around the nurs- 
ing station without interfering. 

Provide clear views of all residents' cor- 
ridors from the nursing station, as well 
as easy access to the medication room, 
clean and soiled utility rooms and linen 
supplies. A nurses' lounge and toilet 
room should be available without requir- 
ing nurses to leave the nursing unit. 
Some nursing stations also provide head 
nurse's and resident physician's offices 
and a teaching/conference facility; these 
provisions will depend upon the nursing 
home's programs and affiliations. 

Design the working surfaces of the nurs- 
ing station to be 29 to 30 inches above 
the floor, with typing or CRT surfaces 
lowered to 25 to 26 inches. The public 



Ill 113 



Nursing Station 




1 
I 


Q 


-L 



DAYROOM/DINING 



STORAGE 



The Nursing Station is a central planning and operational element in the design of nursing 
homes. 



114 III 



Nursing Station 




Counter— The nursing station counter must both function efficiently and provide humane inter- 
action between staff and patients. 



side should be 42 to 48 inches above the 
floor to allow nurses a sense of privacy 
as they sit and work; with this dual 
counter height, nurses need only lift 
their heads to communicate with resi- 
dents and others who approach the sta- 
tion on foot. A section of the counter 
limited to 30 inches in height will allow 
nurses to have face-to-face contact with 
residents seated in wheelchairs or geri- 
atric chairs. 

Lighting and sound control are critical to 
the successful design of a nursing station. 
Task lighting is needed to concentrate 
light on work areas, but it must not 
cause glare on CRT screens or be exces- 
sive during the evening and night hours, 
when residents may be sleeping. Simil- 
arly, the noise of telephone communica- 
tions, dictation, typing, staff conversa- 
tions and the clatter of dishes, food ser- 
vice trays and dropped bedpans must be 



muffled by sound-absorbing surfaces 
and/or partitions with doors, to enhance 
the restful environment needed by 
residents. 

In an effort to make nursing homes 
more homelike, some nursing home pro- 
grams have eliminated the nursing sta- 
tion from the corridor and provided a 
separate office for updating records and 
filing orders. In this plan, someone can 
be on duty at a regular desk in the corri- 
dor, where interaction with residents can 
readily take place. 

Also see Medication Room, Vigil/ Visi- 
tation Room and Nursing Homes in 
Part II: Facility Types. 

OFFICE AND ADMINISTRATIVE 
SPACE 

Staff in a variety of facilities utilized by 
older people need spaces where they can 



Ill 115 



Outdoor Access 



work effectively, have private meetings 
and telephone conversations, and leave 
unfinished business unattended and 
secure. In larger community and senior 
centers, where elderly users need occa- 
sional access to office space, office areas 
should be separated from main activity 
areas. In small facilities, unobtrusive 
office space can be centrally located adja- 
cent to the lounge, lobby/reception or 
multipurpose spaces. 

In multi-unit residential facilities, staff in 
the central management office are gener- 
ally responsible for visitor reception, con- 
trol of resident and visitor access, coor- 
dination of services and general adminis- 
tration. Communication systems for con- 
tact with visitors and for emergency con- 
tact with elevators and with each dwell- 
ing unit should be provided here. 

Nursing home office functions require all 
of the above administrative facilities, 
plus accounting space and office spaces 
for medical staff, nursing staff, dieti- 
cians, social services staff and the man- 
ager of ancillary medical and support 
services — plus medical residents, interns 
and/or students, where appropriate. 
When a nursing home is a component of 
a continuing care retirement community, 
state and local codes often require office 
and administrative spaces to be separate 
from management areas serving the non- 
health components of the community. 



The administrative area should have an 
open, welcoming quality, and give resi- 
dents a sense of security without being 
overbearing. The office should have 
direct access to the building's main 
entrance/exit, lobby and main-floor com- 
mon facilities, especially the mail room. 
It should also, whenever possible, have a 
view of critical areas of the site. 

Also see Activity Areas, Communica- 
tion Systems, Community Spaces, Ele- 
vators, Lobby/Reception Areas, 
Lounges, Multipurpose Rooms, and 
Elderly Housing and Senior Centers in 
Part II: Facility Types. 

OUTDOOR ACCESS 

Access to the out-of-doors is essential for 
most people young and old. Many 
elderly people, however, have reduced 




Duncaster Life Care Center 
Bloomfield, Connecticut 

Stecker LeBau Arneill McManus Architects, Inc. 
Hartford, Conn. 

Maris/Semel New York, Photographer 



116 III 



Outdoor Access 



mobility or must stay indoors as a result 
of ill health or other physical impair- 
ments. For them, creating access to the 
outdoors can become a problem. 

The architect must be careful, when 
designing environments that are both 
supportive and protective of older peo- 
ple, not to create totally internal 
environments. People of any age become 
disoriented when they cannot see and 
feel the outdoors and its changes of light, 
weather and season. 

Activity areas and dining areas should 
not be located in internal environments, 
completely surrounded by other rooms 




Josephine Lum Lodge 
San Leandro, California 

Whisler Path 
San Francisco 

William Helsel, Photographer 



or corridors. Nursing homes with central 
lounges and nursing stations encircled by 
residents' rooms are especially disorient- 
ing to nursing home residents, who find 
they must go to their rooms to see 
outside. 

Windows with views of the activities that 
surround a facility help to provide visual 
access to the outdoors. Sunrooms and 
greenhouses also contribute an outdoor 
feeling without exposing their viewers to 
the elements. Balconies provide ready 
access to outdoor spaces, while limiting 
exit opportunities to those older people 
who may have a history of wandering; 
patios and porches may provide a 
greater wandering and security problem. 

Also see Balconies, Lounges, Site 
Development, Sunrooms, Windows 

and specific room or space. 

PERFORMING ARTS AREAS 

Music, theater and dance groups, 
including elderly performers, frequently 
practice and perform in elderly facilities. 
Locate practice and rehearsal rooms next 
to areas where the sound of practicing 
will not be disturbing, or provide effec- 
tive soundproofing. Design assembly 
areas or multipurpose rooms to facilitate 
public performances. Where musical 
instruments are used, secure storage 
spaces are required. 

Also see Activity Areas, Assembly 
Areas, Multipurpose Rooms and 
Senior Centers in Part II: Facility 
Types. 

PERSONAL CARE 

Personal care services assist older people 
who have difficulty with the normal 



Ill 117 



Ramps 



activities of daily living — bathing, dress- 
ing, preparing meals, eating and toilet- 
ing. Personal care is not health care, and 
thus is not regulated by health-planning 
agencies; it usually comes under the 
authority of state departments of social 
services. 

Personal care services can be delivered 
in an older person's home, or be pro- 
vided in specially designed facilities for 
groups of elderly people with similar 
needs. Such facilities, often called 
residential care facilities, can be found 
freestanding in communities, and as 
components of continuing care retire- 
ment communities, where they provide 
an intermediate level of care that falls 
between that provided in elderly housing 
and that provided by nursing care. 

Also see Adult Day Care, and Residen- 
tial Care Facilities and Continuing 
Care Retirement Communities in Part 
II: Facility Types. 

PRIVACY 

People of all ages need opportunities to 
be alone, and to be left alone. Unfortu- 
nately, observation and supervision are 
important parts of higher-level care for 
older people who face the risk of life- 
threatening disease or accident. When 
assistance is required in a person's most 
private activities — bathing, toileting and 
dressing — other opportunities to enjoy 
private moments are lost. 

Design for privacy involves more than 
visual screening. Resident embarrass- 
ment during such private activities as 
toileting frequently stems from the lack 
of acoustic privacy and odor con- 



trol — amenities that are afforded by 
spaces with doors on them (such as 
private rooms, baths, toilets, etc.). 

In nursing homes, the privacy offered by 
a normal space hierarchy is also dis- 
rupted by the absence of lockable doors, 
vestibules, private hallways and often 
private bedrooms. 

Provide physical opportunities for 
privacy in facilities designed for older 
people by limiting views into private 
spaces, and by restoring a normal space 
hierarchy through the use of "front 
porches," vestibules and other kinds of 
space that make up the sequence from 
"public" to "private." 

Also see Bathroom-Private, Bedrooms, 
Central Bathing, Residents' Rooms, 
Space Hierarchy, and Nursing Homes 
in Part II: Facility Types. 

RAMPS 

Through good design, ramps can be 
avoided in facilities used by the elderly. 
Eliminating ramps alleviates the hazards 
that ramps pose to the many elderly who 
walk with an off-balance, shuffling gait, 
and removes the barrier that ramps pre- 
sent to those who lack the strength or 
stamina to negotiate an incline. Many 
ambulatory people find wheelchair 
ramps uncomfortable and even impossi- 
ble to use, so stairs should be included to 
provide an alternative to ramps for some 
level changes. In many facilities, how- 
ever — and particularly in nursing 
homes — wheelchairs are used by the 
majority of occupants, either full-time or 
occasionally. Accommodating both 
ambulatory people and wheelchair users 
may therefore require multiple paths 



118 III 



Ramps 



wherever a level change is required. 
Wheelchair users must also enjoy easy 
access to tables, counters and building 
controls. 

If the use of a ramp is unavoidable, a 
maximum gradient of 1 to 20 is recom- 
mended; this is a more gradual slope 
than the 1 to 12 maximum gradient 
allowed by ANSI A117.1 under limited 
conditions. To accommodate wheelchair 
users as well as ambulatory individuals, 
provide level landings at the top and 
bottom of the ramp, and at every 40 feet 
of horizontal travel. Provide ramps at 
least six feet long and five feet wide, free 
of door swings, and with smooth, non- 
slip surfaces. Provide handrails on both 
sides of the ramp, extending a minimum 
of one foot beyond the ramp's terminals. 
Gradients less than 1 to 20 are not 
required to be considered as "ramps," 
and thus do not require landings and 
handrails. 

Ambulatory users will also appreciate 
benches or other opportunities to rest 
and regain stamina and strength at stair 
and ramp landings. 

Also see Barrier-Free Design, Hand- 
rails, Site Development, and refer to 
barrier-free design standards. 

READING/LIBRARY AREAS 

Locate reading and library areas away 
from — or shielded from — noise and other 
distractions. Older readers often need 
higher levels of illumination. Those 
higher levels may be best provided with 
variable-luminance or variable-position 
task lighting that can be individually 
controlled by the user. Avoid peripheral 
glare, and provide appropriate seating. 




Michael R. Koury Terrace 
Torrington, Connecticut 

Ulrich Franzen & Associates, Architects 



Also see Activity Areas, Lighting and 
Seating. 

REDUNDANT CUEING- 

Redundant cueing is utilized to commu- 
nicate with older people who have sen- 
sory or cognitive impairments, by send- 
ing the same message in more than one 
sensory mode, or in more than one way 
in the same sensory mode, or more than 
once in different times and/or places. 
Alarms, for example, are generally 
required to emit visual as well as audible 
signals in case of fire. 

Many visual alarms incorporate white 
strobe lights in addition to red flashing 
lights to communicate warning signals. 
The redundant cueing concept also 
applies to helping older people with way- 
finding in a building by, for example, 
changing the texture of the floor cover- 
ing at an intersection in a corridor as 
well as changing the color and lighting 
schemes, and continuing those patterns 
throughout the defined area. 

Also see Communication Systems and 
Wayfinding. 



Ill 119 



Residents' Rooms (Nursing Homes) 



RESIDENTIAL SERVICES 

Reidential services are simply those ser- 
vices provided in the home. Many older 
people, for example, could live indepen- 
dently except for the difficulty they have 
with food shopping, cooking or cleaning 
house; residential services in these areas 
are delivered to the elderly person's pri- 
vate home — as are meals-on-wheels — or 
provided in specifically-designed residen- 
tial facilities, such as congregate housing. 

Residential services range from house- 
keeping services and food services — 
including central food services, snack 
bars, and private kitchens and dining 
areas — to such retail-oriented services as 
beauty, barber, gift, sundry and snack 
shops. 

Also see Congregate Housing, Dining 
Areas, Housekeeping, Kitchens, Nour- 
ishment Stations, Shops, Snack Bars, 
and Senior Centers and Continuing 
Care Retirement Communities in Part 
II: Facility Types. 

RESIDENTS' ROOMS 
(NURSING HOMES) 

A resident's room in a nursing home is 
the place of greatest importance to the 
resident — the place in which most of his 
or her time is spent. Residents' rooms 
should provide a truly residential quality 
to the greatest extent possible. Each resi- 
dent should have maximum feasible con- 
trol over the furniture and its arrange- 
ment; over lighting, heating and cooling 
levels; over the furnishings within the 
room. And each resident should be able 
to exercise other forms of personal con- 
trol, including choice of company and 
activity, of social interaction and pri- 
vacy. He or she should feel a sense of 



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Territory— A sense of personal space or 
one's own territory is very important to the 
overall well being of nursing home residents. 

personalization, of identity and belong- 
ing; of control of territory and expression 
of ownership, and finally of full accessi- 
bility, including maneuvering and trans- 
ferring to bed from a wheelchair. The 
number of beds that should be in resi- 
dents' rooms is a highly controversial 
subject. Some policy makers who are 
trying to reduce the costs of nursing 
home care view the multibed room as an 
opportunity to save money. Senior citi- 
zens' groups and other advocates view 
the multibed room as an unnecessary 
deprivation of privacy and environmen- 
tal control. Consider the following 
recommendations : 

• Limit maximum capacity to two beds 
per room; more than two beds per 
room makes it extremely difficult, if not 
impossible, to provide for the needs 
listed above. 



120 III 



Residents' Rooms (Nursing Homes) 



• Provide a high proportion of private 
residents' rooms — up to 80 percent of 
facility occupancy. 

• Design double-occupant rooms to per- 
mit both a clear demarcation of per- 
sonal space and a measure of privacy. 
Proponents of biaxial plans (see illustra- 
tion) cite advantages based upon satis- 
faction of residents' criteria and needs. 
Proponents of axial (or assymetrical) 
plans cite both initial capital cost and 
operating cost savings, because the 
resultant nursing unit layouts are 
smaller in area, perimeter and staffing 
requirements (advantages that increase 
in proportion to distances traveled). 

• Provide sufficient floor area to accom- 
modate the relationships, activities and 
furniture described below. 

Five distinct uses of space have been 
identified within the typical resident's 
room. Each functional area must facili- 
tate a different type of activity: 

• Privacy resting/sleeping space, which 
includes the bed, is also the space from 
which the resident can control the rest 
of the room. Provide four feet of clear- 
ance between the bed and all other 
objects and walls wherever wheelchair 
access is to be provided. Plan for alter- 
natives for bed location to allow the 
resident to arrange the room according 
to personal preference. Consider bed 
locations that offer views out of the win- 
dows and that provide good positions 
for television watching. Provide ceilings 
with visually stimulating surfaces, tex- 
tures and patterns, especially in areas 
visible from the bed. Consider double- 
track drapery fixtures to accommodate 
both consistent outer drapes and resi- 
dents' personal interior drapery choices. 



• Controlled social space is used for personal 
activities and for private interaction 
with family and friends. Plan for flexi- 
bility in furniture arrangements. Pro- 
vide two armchairs, a 28-to-30-inch- 
high table and a reading lamp. Provide 
for visual and aural privacy with light- 
ing, partial walls, planters, partitions, 
hangings and/or panels that can be 
arranged by the resident. 

• Open social space functions as a vestibule 
or transition space connecting to the 
corridor, the resident's toilet room and 
the personally controlled social space. 
Nursing home staff and visitors may 
enter here and be recognized before 
penetrating the personal space of the 
resident. 

• The resident's toilet room is often the only 
private space for occupants of multibed 
rooms. Toileting activities, however, are 
often carried out with the assistance of 
nursing home staff (see Toilet Rooms). 
Provide enough space to accommodate 

a wheelchair as well as an assistant. 

• The threshold area is located at the resi- 
dent's door to the corridor. Provide 
space for decoration of the entry with 
plantings, mailboxes, chairs and other 
personal items. These artifacts help 
mark the space as belonging to the resi- 
dent; they also provide variety to the 
corridor. 

Other areas and attributes of the resi- 
dent's room also require special design 
attention: 

• Display space, which gives the resident 
the opportunity for self-expression and 
personalization in the room. Provide 
display space in all areas of the resident's 
room. Provide strip mouldings or other 
devices for the suspension of wall hang- 



Ill 121 



Residents' Rooms (Nursing Homes) 



ings, especially in the privacy (bed) and 
controlled social spaces, and provide 
moveable shelving units to increase the 
horizontal surface area available for dis- 
playing personal items. 
Storage space for personal belongings and 
effects. Provide drawer- type storage and 
cabinet storage for personal effects used 
daily, and for possessions important to 
previous life styles. Closet storage is 
required for in- season clothing and 
larger items. Locate long-term storage 
for occasionally used artifacts and furni- 
ture outside the resident's room, where 
they will be readily accessible to the 
resident. 

Thermal comfort. Older residents are 
highly vulnerable both to drafts and to 
swings in temperature. Thermostats 
that are operable by the residents allow 
self-regulation for thermal comfort (see 
Heating, Ventilating, and Aircon- 
ditioning). 

Lighting. Provide adequate light levels 
for specific tasks and high contrasts for 
changes in surface (see Lighting). Con- 
trol reflection and glare. Flexibility in 
the positioning of light sources and the 
changing of illumination levels will 
allow residents to adjust lighting to suit 
their conditions and activities. Many 
older nursing home residents require up 
to twice the task-specific illumination 
levels required by younger people with 
"normal" vision. 

Sound control and attenuation. Most nursing 
home residents have difficulty hearing. 
Age-related hearing loss is often fre- 
quency-specific; only small segments of 
the total range of audible frequencies 
are lost, most often in the higher fre- 
quencies. This makes conversation diffi- 
cult because parts of words may be 
"clipped" when the speaker's voice 



moves into an inaudible frequency. 
Within the room, provide sound attenu- 
ation for the lower frequencies and pro- 
vide a more "live" or reflective envir- 
onment for the higher frequencies. 
Isolate sound and noise between rooms 
to reduce transmission of the high 
sound levels created by television or 
conversation (see Sound Control). 
The resident's bed is the total environment 
for some nursing home residents. Do 
not provide a hospital bed. The provi- 
sion of more than one type of bed in 




The Resident's Room should provide a resi- 
dential quality to the greatest extent 
possible. 



122 III 



Residents' Rooms (Nursing Homes) 



the nursing home is recommended, so 
that different beds can be utilized for 
different personal and nursing care 
requirements. Provide residents' beds 
that can be personalized, with top 
coverings supplied by the residents. 
Provide beds and surrounding furniture 
with rounded corners and/or soft sur- 
faces, to minimize injury from slips and 
falls in the bed area (see Beds). 
• Furniture provided by the facility for resi- 
dent use should have a residential — as 
opposed to institutional — look and feel. 
Provide adequate space for the resident 
who wishes to bring in a piece of his or 
her own furniture (although some states 
prohibit the use of residents' nonstan- 
dard beds). Room furniture should 
(minimally) include a bed, a dresser or 
chest of drawers, night tables, a televi- 
sion, two armchairs, a 30-inch-high 
table and a reading lamp. Design rooms 
to allow for a variety of personalized 
furniture arrangements. 

Also see Beds, Control, Dining Areas, 
Doors, Furnishability, HVAC, Light- 
ing, Seating, Toilet Rooms, Windows 
and Nursing Homes in Part II: 
Facility Types. 

RESPITE CARE 

Respite care is temporary care for 
impaired elderly people. Its main goal is 
to relieve the primary care- givers — 
usually family members. Respite care is 
available in nursing homes, board and 
care facilities, and in individual homes. 

Also see Residential Care Facilities and 
Nursing Homes in Part II: Facility 
Types. 



RETIREMENT COMMUNITIES 

The first retirement communities in the 
United States were built in the 1920s, 
but the majority have been constructed 
since World War II. Several terms are 
used to denote communities of different 
size: 

• Retirement towns generally house more 
than 5,000 inhabitants. 

• Retirement villages generally house 1,000 
to 5,000 inhabitants. 

• Retirement subdivisions generally house 
any number from 100 to 500 and up to 
1,000 inhabitants. 

• Elderly housing generally encompasses 
100 to 500 separate dwelling units. 

Retirement towns and villages usually 
include various groupings of detached 
houses, townhouses, multistory apart- 
ment buildings and/or mobile homes, 
and usually feature recreational facilities 
and accommodations for social gather- 
ings. The typical retirement subdivision 
is planned as a part of the surrounding 
environment; it usually contains only 
limited services and facilities for resident 
use, and consists of lowrise structures. 

Elderly housing, which characterizes 
approximately half of all retirement com- 
munities, is generally provided in mid- or 
highrise buildings and located in urban 
areas, near public transportation, shop- 
ping and medical services. Its construc- 
tion is often financed under the sponsor- 
ship of nonprofit groups such as 
churches, unions or benevolent organ- 
izations. 

Also see Continuing Care Retirement 
Communities and Elderly Housing in 
Part II: Facility Types. 



Ill 123 



Seating 



SAFETY 

Accidents. The multiple diseases and 
disabilities of aging render some older 
people particularly vulnerable to acci- 
dents. Injuries from falls present a major 
problem. A single fall can result in a 
radical change in an older person's life. 
For example, an older woman living 
alone who breaks her hip in a fall may 
suddenly be forced to move into a nurs- 
ing home because she can no longer care 
for herself. This situation, which may be 
temporary, leads to the sale of her house 
or the loss of her apartment, because of 
her inability to keep up the maintenance 
or afford rent. 

Fire Safety can also be a problem with 
older people. They may forget to turn 
off the stove, may not smell gas or 
smoke, may be unable to quickly evacu- 
ate a building in an emergency or, if 
forced to move quickly, may fall and 
injure themselves. For preventive as well 
as emergency protection, stoves can be 
fitted with timing or thermal-protection 
devices, and gas and smoke alarms can 
be installed. 

Also see Balconies, Bathrooms, Beds, 
Communication Systems, Exits, and 
Heating, Ventilating and Air 
Conditioning. 

SEATING 

The selection of seating for facilities used 
by older people is of great importance. It 
is typical for elderly people to sit for 
extended periods, to have poor blood cir- 
culation and to have difficulty transfer- 
ring into and out of seats. These condi- 
tions are especially characteristic of nurs- 
ing home residents. 



Chairs. Good chairs for elderly users are 
hard to find and should be carefully 
researched by the specifier. A manufac- 
turer's designation of a chair as a "geri- 
atric chair" or as being "for use by the 
elderly" is no guarantee of suitability. 

The major functional considerations that 
are central to chair selection are: 

• Ease of getting into the chair, 

• Comfort and support while sitting or 
reclining in a dignified position, 

• Ease of getting out of the chair. 

A prospective chair can best be tested for 
its performance in these areas personally, 
by an architect who is aware of the 
infirmities of the particular older-user 
group involved; such testing is always 
preferable to relying on pictures and 
descriptions. 

• Chairs that are not too heavy to move 
are recommended so that seating 
arrangements can be easily adapted by 
older users for good eye contact, and 
listening. 



V-A5"M#i 




1'-2" TO V-5 

SEAT HEIGHT 



Chairs— Selection of good seating deserves 
careful attention from the architect. 



124 III 



Seating 



Fixed and Movable Seating. In semi- 
public outdoor spaces, movable seating is 
preferred by many older persons. Elderly 
residents want to control their own seat- 
ing arrangements and make their own 
choices of location, orientation, view and 
conversation group. 



When fixed seating is provided in public 
outdoor spaces, it should be located 
approximately every 200 feet. Locate 
benches within 20 feet of pathways, 
where they will not interfere with traffic. 
Alignment of seating areas and walkways 
with sun lines and existing trees can 




Outdoor Seating should provide a combination of fixed and movable arrangements. 



Ill 125 



Senile Dementia 




Amistad House 
Berkeley, California 

Whisler Patri 
San Francisco 

Michael E. Bry, Photographer 



maximize sun in the winter and shade in 
the summer. 

Also see Activity Areas, Assembly 
Areas, Dining Areas, Lounges, 
Ramps, Site Development and Stairs. 

SECURITY 

Many older people are especially vulner- 
able to assault, robbery and burglary. 
Older people are generally likely to offer 
less resistance and to incur greater injury 
in an attack. Some severely limit their 
activities because they fear being 
attacked. 

The architect can help reduce these fears 
(and their cause) by making sure that 
spaces are well illuminated and provide 
no hiding places, and that areas can be 
surveyed by older users before they com- 
mit themselves to entering. Other 



"defensible space" design features that 
increase observation, limit access and 
facilitate communication and apprehen- 
sion are extremely effective in elderly 
housing projects and communities 
because the residents are usually there all 
the time. These include view-ports or 
"peepholes" and security locks in resi- 
dents' entrance doors. 

Sophisticated security communications 
and alarm systems that are becoming 
available incorporate intercom, television 
monitoring, telemetric and medical diag- 
nostic and monitoring capabilities; these 
increase both the real and perceived 
security of elderly residents. 

Also see Communication Systems, Site 
Analysis and Site Development. 

SENILE DEMENTIA 

Senile dementia, or simply "dementia," 
is one of the two major types of mental 
illness affecting older people (the other 
being depression). Dementia is a clinical 
syndrome characterized by the progres- 
sive deterioration of cognitive function, 
usually accompanied by changes in emo- 
tions and personality. The causes of 
dementia are varied and ill-defined at 
this time. 

The prevalence of severe dementia 
among elderly people is estimated to 
range from one percent to six percent. 
The prevalence of dementia increases 
markedly with age, so that by the age of 
80 the prevalence of severe dementia 
increases to 20 percent. 

Alzheimer's disease is the most statisti- 
cally significant kind of dementia, 
accounting for an estimated 50 percent 



126 III 



Senile Dementia 



to 75 percent of dementia cases. The 
remainder are due to arteriosclerotic 
brain disease and other specific organic 
brain disorders. The prevalence of Alz- 
heimer's disease at age 80 is estimated to 
be 17 percent, rising to 30 percent by 
age 85. 

The effects of dementia can include the 
inability to recall who or where one is, 
who one's family and friends are or 
where one lives, as well as the inability 
to attend to such everyday tasks as dress- 
ing, toileting and eating. Aimless wan- 
dering, extreme emotions and violent 
behavior also characterize many demen- 
tia patients. 

Dementia has proven difficult to diag- 
nose because many of its symptoms 
resemble mild disorientation. It is impor- 
tant, however, not to assume that all older 
people who are slow to make decisions, 
who are a little forgetful or who are 
unsure of themselves are "senile" or suf- 
fering from Alzheimer's disease. 

From an architect's Doint of view, 
dementia presents many surprises. Many 
dementia patients tend to misinterpret 
architectural elements or visual cues; for 
example, mistaking sliding glass doors 
for windows and becoming frustrated 
when failing to find a door that opens 
"the way doors should" (that is, swing- 
ing on hinges instead of sliding). Since 
architectural frustrations can seriously 
anger some dementia patients, some- 
times even triggering physically damag- 
ing episodes of outrage, facility design 
for these patients should be undertaken 
only by experienced architects working 
in close consultation with specialized 
medical and nursing staffs. 



Also see Part I: Introduction — Aging 
and the Environment. 

SHOPS 

Space for small shops — flower, gift, 
beauty, barber, sundry and convenience 
food shops — is often provided in the 
community centers of continuing care 
retirement communities, as well as in 
nursing homes and larger congregate 
housing projects. For many older people, 
reduced mobility can severely limit 
access to off- site shops, and thus limit 
their ability to care for themselves. On- 
site shops also help to create activity 
within a building (especially when some 
of the shops are run by residents) and 
can foster among residents- a greater 
pride in their personal appearance and 
independence. 

Design on-site shops for accessibility (see 
ANSI A117.1 or the applicable barrier- 
free design standards), with good illu- 
mination (see Lighting). The develop- 
ment of alcoves or sidewalk cafelike 
table-and-chair settings in shop-front cor- 
ridors can provide places to sit, watch, 
meet, greet and even enjoy an ice cream 
cone in good company. 

Also see Barrier-Free Design, Con- 
gregate Housing, Lighting, Residential 
Services, and Senior Centers, Nursing 
Homes and Continuing Care Retire- 
ment Communities in Part II: Facility 
Types. 

SIGN SYSTEMS 

Every facility should have identifying, 
directional and informational signs (see 
Wayfinding) located at the main entry. 
Signs, if they are to be seen by visually 
impaired people, should be color-con- 



Ill 127 



Sign Systems 




Signs should have large lettering, contrasting background, and be without glare. 



trasted to their backgrounds and feature 
large letters. Non-glare accent lighting or 
backlighting to highlight signs also aids 
visibility. 

Directories. Finding one's way to, into 
and within a building can present many 
difficulties for some older people. A 
building directory can be of assistance if 
it is prominent and readable. Directories 
should contain information on tenant 
locations within the building, as well as 
floor plan diagrams in both visual and 



tactile formats. When there is no recep- 
tion desk, the directory should be the 
first thing one comes to inside the main 
entry. 

A major problem with many directories 
is that they function more as mirrors 
than as signs. "Mirror" directories are 
those covered with glass and located near 
glass doors and windows that create 
glare and reflect multiple images on the 
directory's glass cover plate. Many 
elderly people simply cannot read at all 



128 III 



Sign Systems 



in high-glare situations; thus, the archi- 
tect should either not use a reflective 
cover on the directory or locate and/or 
shield the directory so as to eliminate 
glare and reflection from the cover plate. 
White letters on a black background are 
recommended. Backlighting of direc- 
tories also helps to present highly read- 
able characters. 

Signs. In facilities for the elderly, 
interior signs should use white symbols 
on a dark or black background. 

Floor numbers should be clearly read- 
able when viewed from an open elevator 
door. Signs should be located at wheel- 
chair eye-level (48 to 52 inches from the 
floor) for easy reading from both a 
standing or sitting position. Visual emer- 
gency-exit signs should be located 48 to 
52 inches from the floor, so that they 
can be seen either from a wheelchair or 
from the floor when smoke has collected 
at the ceiling. 

Nonsign Markers. Landmarks, plants, 
pictures, changes in color schemes, 
noises and smells all help to identify 
places. Color-coding and supergraphics 
should be used with care, to preserve a 
residential atmosphere. 

Also see Barrier-Free Design, Entries, 
Lighting, Lobby/Reception Area, 
Wayfinding, and refer to barrier-free 
design standards. 

SITE ANALYSIS 

The selection of a site to accommodate 
facilities for the elderly involves many 
factors, among them area requirements, 
location, available transportation, shop- 



ping, social services, neighborhood, 
parking, solar orientation, topography, 
utilities and zoning, water supply and 
sewage facilities, as well as cost. 

Location of any facility designed for 
older users depends upon a number of 
factors — availability, cost and zoning 
among them. These are considerations 
that may be beyond the control of the 
architect, yet the client will want the 
architect's advice regarding their poten- 
tial impact on facility planning and 
design. 

A retirement facility should be located 
where its older users want it to be, and 
where they will have easy access to off- 
site friends, services (doctors, dentists, 
libraries, stores, etc.) and activities with- 
out encountering traffic hazards or steep 
grades. The vast majority (80 percent) of 
the elderly retire to locations within eight 
miles of their preretirement homes, 
where they are familiar with the commu- 
nity and its resources, and can sustain 
contacts with friends and relations. 

Neighborhoods often have a special sig- 
nificance to older people because of the 
many friendships they have formed in 
their long years there (nearly half of all 
owner-occupants of elderly housing in 
America have lived in their neighbor- 
hoods for 25 years). When older people 
move from their homes and neighbor- 
hoods to elderly housing or to a retire- 
ment community, many of those long- 
standing relationships are weakened or 
severed. 

In selecting a site for a new facility for 
the elderly, it can be important to locate, 



Ill 129 



Site Analysis 




Hebrew Home for the Aged 

The Gruzen Partnership 
New York 

Elliot Fine, Photographer 



whenever possible, near the existing 
neighborhoods of many of the prospec- 
tive tenants. Close proximity to services 
and amenities that the residents are 
accustomed to using, such as shops, 
clinics and places of worship, is also 
important. 

Security is a primary concern for many 
older people, and for facility location as 
well. Neighborhoods already populated 
by many older people — people who may 
utilize the facility — are preferable to 
younger or transitional neighborhoods. 

Topography. Most older people have 
some difficulty climbing or descending 
steep slopes and the stairs and long 
ramps used to traverse high grades. The 
optimal site for an elderly facility will 
have relatively flat topography, or topog- 



raphy that can be effectively stepped, 
with relatively level areas for outdoor 
activities. Consider planning site circula- 
tion through the buildings so that eleva- 
tors can be utilized to change grade 
while crossing the site. 

Transportation. Visual impairments 
and other health risks often reduce or 
eliminate the elderly person's opportuni- 
ties for driving, so the availability of 
public transportation is an important fac- 
tor in site analysis. 

Zoning. The problems and opportuni- 
ties presented by zoning regulations can 
have special significance for facilities 
designed for older people. In residential 
projects, in particular, parking and den- 
sity requirements can prevent the effi- 
cient use of a site. 



130 III 



Site Analysis 




Michael R. Koury Terrace 
Torrington, Connecticut 

Ulrich Franzen & Associates, Architects 



Depending on the characteristics of 
potential residents and the location of the 
project, a parking requirement as low as 
X A -space per dwelling unit may be suffi- 
cient. In many jurisdictions, special den- 
sity-multiplication factors are allowed for 
elderly housing; they allow higher densi- 
ties than for general housing. Special 
treatment in other zoning aspects is often 
available because authorities recognize 
that the impacts of elderly housing on 
neighborhoods and service struc- 
tures — schools for example — is different 
from that of general housing. 

Also see Accessory Apartments, Area 
Requirements, Security and Site 
Development. 



SITE DEVELOPMENT 

Facilities designed for the elderly present 
special site development concerns. First, 
older people may have difficulty finding 
their way to the site entry, into the site 
and to the main building entry, as well 
as difficulty finding their way once inside 
the building. Second, many older people 
cannot walk long distances or up and 
down steep grades and steps. These 
problems call for special design solutions 
that will help older users identify site, 
site entrance and building entrance, and 
enable them to move around inside and 
outside the building. 

Consider sign systems, views onto the 
site and the visual readability of build- 
ings and site. In sequence, the entrance 



Ill 131 



Site Development 




Lafayette Place 

Fall River, Massachusetts 

Boston Architectural Team, Inc. 

Hresko Associates, Boston 
Phillip Hresko, Principal 
David Clark, Job Captain 

Nick Wheeler, Photographer 



to the site should follow a clear announce- 
ment of the identity of the facility, and 
be clearly marked. The building contain- 
ing the main entry should be visible 
from the site entrance or a point close to 
it and the road should clearly flow to the 



front of that building. The main entry 
should be easily identifiable (by its all- 
weather loading area) and be the open- 
ing element of an accessible route into 
the building (see ANSI A117.1 or the 
applicable barrier- free design standards). 



132 III 



Site Development 



Outdoor Spaces. The provision of well 
planned outdoor common spaces for resi- 
dents can help alleviate the isolated feel- 
ing often associated with facilities for the 
elderly, and particularly associated with 
highrise facilities. A variety of activities 
can be provided for the out-of-doors, 
ranging from quiet conversation to 
games and swimming. 



When planning outdoor spaces (and 
indoor activity areas), the architect 
should attempt to recreate a sense of 
neighborhood. The spaces should attract 
people to opportunities for socialization, 
recreation and passive rest, and promote 
their positive participation by evoking a 
warm and familiar environment. 




Outdoor Spaces— The design of good outdoor spaces is equally as challenging as the design of 
the building plans. 



Ill 133 



Site Development 




Outdoor Spaces— Landmarks play a role in orientation both outdoors and in. 



For sitting areas, paved terraces with 
moveable seating are recommended. 
Locate seating with a view of circulation 
arteries and other activity areas, but 
without interfering with the circulation 
path. Clearly differentiate outdoor pri- 
vate spaces from communal spaces in 
elderly housing and continuing care 
retirement communities. Ensure that 
wind protection is provided either by 
buildings or by supplementary wind bar- 
riers. When necessary, provide acoustic 



barriers to reduce street and background 
noises. 

Patios can provide the kind of controlled 
outdoor access that is often important for 
older people. A patio can be planned to 
accommodate such group activities as 
barbecues and picnics, and it can pro- 
vide seating for individuals and small 
groups who simply enjoy sitting 
outdoors. 



134 III 



Site Development 




Park Glen, Housing for the Elderly 
Taylorsville, Illinois 

Nagle, Hartray & Associates/Ltd. 
Chicago 

Howard N. Kaplan HNK Architectural Photography 



Provide barrier-free access from building 
interior to patio without steps and with- 
out a threshold. Utilize smooth, slip- 
resistant paving materials, with a slope 
of no more than 1/8 inch to the foot. 
Seating should be moveable. 



A good location for a patio is next to a 
lounge or other activity area where 
people who enjoy watching, but prefer 
not to go outside, can find a vantage 
point. 



Ill 135 



Site Development 



Locate outdoor recreation areas where 
they will receive daily sunlight in the fall 
and winter and shade in the summer. 
Provide clearly defined spaces for games 
(particularly horseshoes) to be played in 
actively used areas, and include accom- 
modations for any locally popular games 
and activities. If pets are allowed, the 
designer should consider where they will 
be walked and where dogs will be 
curbed. Both HUD and the Farmer's 
Home Administration have rules govern- 
ing pet ownership in federally assisted 
housing. Some nursing homes provide 
exterior kennels. 

Locate equipment storage and a shaded 
sitting space for spectators adjacent to 
game spaces. If outdoor eating, picnic 
and barbecue areas figure in the design 
of the outdoor space, locate them close 
to indoor kitchen and bathroom facili- 
ties. Consider the inclusion of individual 
garden spaces (or a greenhouse) to allow 
residents to raise their own flowers and 
vegetables. 

Landscaping. Utilize orientation cues 
and devices in the design of landscaped 
areas (see Wayfinding). Design walkway 
grades and surfaces for wheelchair acces- 
sibility, and to allow the elderly stroller 
to visually explore a series of landscapes 
from the walkway. 

Plantings located at waist height are 
more easily seen, touched and smelled 
than those at ground level. Landscapes 
that present high contrasts between and 
among landforms and plantings are 
more visible to many older people; sub- 
tle changes in color or form may not be 



perceived. Many older people are quite 
fond of colorful flowering plants. Flower- 
ing trees and fruit trees also are prefer- 
red, though many of these species tend 
to be messy from a housekeeping or 
grounds maintenance point of view. 

Parking. Design parking areas for ease 
of circulation and a minimum of confu- 
sion. Provide good lighting and mini- 
mize concealment for intruders. Clearly 
mark drop-off points, and make them 
visible from both community areas and 
living units. In elderly housing, provide 
a minimum of two accessible parking 
spaces, with additional accessible spaces 
provided on an as-needed basis (see 
ANSI A117.1 or applicable barrier- free 
design standards). 

Depending on the location of the project 
and the particular characteristics of its 
residents, a parking requirement as low 
as 1/4-space per dwelling unit may be 




Parking Areas should be designed for 
optimum circulation and accessibility. 



136 III 



Site Development 



sufficient. For new elderly-housing and 
continuing care retirement communities, 
parking for a one-car-to-one-dwelling- 
unit ratio may be required initially, 
because most residents may still be driv- 
ing when they move into the facility. 
After the facility is several years old, 
parking spaces for 25 to 50 percent of 
the units may be sufficient, depending 
on location and access to shopping and 
public transportation. Locate parking 
close to the unit rather than in one large 
lot, and avoid blocking or dominating 
views. 

For community and senior centers, ade- 
quate parking is often crucial, and 
increasingly so when public transporta- 
tion is limited. Locate parking no farther 
than 200 feet from the entrance to the 
center or from a shelter or enclosure. A 
minimum of one route from the parking 
area, bus stop, loading zone or sidewalk 
must be wheelchair accessible. 

In many urban areas, security is a vital 
function both for parking areas and for 
the route from parking to the facility. 
Provide a higher level of uniform illu- 
mination in these areas to enable older 
people to notice intruders. In urban cen- 
ters, free and secure parking may be an 
essential recruiting device in order to 
attract staff to a less than ideal neighbor- 
hood, even if public transportation is 
available. 

A loading area of at least 5 feet by 30 
feet will accommodate unloading from 
cars and minibuses. Curbs are not 
recommended in this area; the walk 



should be feathered to the pavement 
with a slope of 1/8 inch to the foot. Pro- 
vide bollards to separate auto/pedestrian 
circulation. Provide a direct view of the 
loading area from the main entry and 
the lobby/reception area. 

Solar Orientation. Most of the spaces in 
any facility designed for the elderly 
would benefit from sunlight at some time 
during the day. Buildings should be ori- 
ented to maximize the number of differ- 
ent private spaces — including residents' 
rooms and dwelling units — that can 
receive sunlight; community spaces 
should provide sunlight for all residents. 
Careful building orientation can also 
extend the seasons outdoors by maximiz- 
ing solar exposure for such outdoor areas 
as patios and common balconies, and by 
reducing snow and ice accumulation on 
walks at entrances. 

Heat gain from direct insolation can 
be a greater problem for older people 
than for younger (see HVAC); provide 
solar controls (such as dropped window 
heads) and mechanical systems adequate 
to maintain proper room temperatures. 

Walkways. For major walkways on any 
elderly facility site, provide a minimum 
width of six feet. Provide a minimum 
width of five feet for walkways in out- 
door common areas with heavy traffic. 
Other walks can be three feet in width if 
periodic passing areas are provided. 
Concrete walkways with a broomfin- 
ished, non-slip surface are recom- 
mended. Consider a special band of tex- 
tured, nonslip paving at building 
entrances. Provide good lighting for all 



Ill 137 



Site Development 







Walkways can provide opportunities for social interaction. 



paths, utilizing lighting fixtures that will 
not present a hazard to the residents. 

Plan walkways that are easily accessible 
from residential units, with one major 
pathway connecting major on-site and 
off-site activities. Design walkways to 
provide a variety of stimuli to resi- 
dents — perhaps with games located 
alongside to encourage chance encoun- 
ters. Plan intersections to accommodate 
greater concentrations of traffic and 



social interaction. Avoid locating walk- 
ways in areas subject to heavy icing and 
snow drifting. 

Also see Activity Areas, Balconies, 
Barrier-Free Design, Community 
Spaces, Entries, Exits, Lighting, Out- 
door Access, Seating, Sign Systems, 
Site Analysis, Wayfinding, Major 
Building Types in Part II: Facility 
Types, and refer to barrier-free design 
standards. 



138 III 



Snack Bars 



SNACK BARS 

A snack bar provides a place where facil- 
ity residents, staff, and their guests can 
go for coffee, pastries and other light 
food and drink items at any time of the 
day or night. Snack bars usually contain 
a coffee maker, a cook top or hot plate, 
drink/candy/pastry vending machines, 
dry and cold storage, a kitchen sink and 
a counter top where simple dishes might 
be prepared. Snack bars are for the use 
of older residents who are capable of 
using them in a safe and responsible 
manner. Provide keys to the snack bar 
for residents who are capable. Those 
residents who prove to be unsafe or irre- 
sponsible will have to be supervised in 
the use of the snack bar. 

Snack bars are especially useful in facili- 
ties that do not provide private kitchens 
or private cold storage. In cases such as 
these, a snack bar might be designed as 
part of a full-featured kitchen that is pro- 
vided for occasional use to the residents, 
who take most of their regular meals in 
a central dining room. 

Storage, preparation and dispensing 
equipment in the snack bar — including 
vending machines — should be fully acces- 
sible to and useable by the residents (see 
ANSI A117.1, Barrier-Free Design and 
Kitchens). The snack bar should be 
centrally located in the residential area of 
the building, where the space can also be 
used for meeting, greeting and watching. 

Also see Barrier- Free Design and 
Residential Services. 



SOCIAL SERVICES 

Information, referral and counseling are 
services often provided in facilities 
designed for the elderly. These social 
services help older people adapt to retire- 
ment, lowered income, the loss of friends 
or family, ill health, impairment, and 
the other eventualities of aging — includ- 
ing moving to new housing and health 
care environments. The provisions of 
social services may require permanent 
office space with file storage and an area 
for conferences with individual older 
persons. 

Also see Office and Administrative 
Space. 

SOUND CONTROL 

Age-related hearing loss is often fre- 
quency-specific, with only small seg- 
ments of the audible frequency spec- 
trum — usually in the higher range — 
affected. Elderly people with hearing dif- 
ficulties can be aided by attenuation of 
the lower frequencies and control of 
background noise. 

General background noise can be 
reduced by using carpeting or other 
floor, wall and ceiling materials and fin- 
ishes that reduce sound reflection. In 
large open spaces, background noise can 
be reduced with baffling, wall hangings, 
banners and panels. Eliminating 
unnecessary sources of background 
noises at entries, crowded areas and 
intersections will also ease the orientation 
and wayfinding process. 



Ill 139 



Stairs 



Privacy can be enhanced through proper 
sound control, particularly in residents' 
rooms, bathrooms and toilet rooms. 
Doors should be provided without sound 
passing air- transfer grilles, to isolate 
sounds of private functions, such as 
bowel movements, that tend to embar- 
rass residents who believe they're being 
overheard by roommates or staff. 

Also see Residents' Rooms. 

SPACE HIERARCHY 

Research into residential facilities has 
shown that categories of space range 
from "public," where strangers as well 
as residents may enter, to "private," 
where only one's closest intimates are 
allowed entry. To separate and protect 
these different uses of space, the spaces 
themselves are generally arranged along 
a hierarchy ranging from "private" 
through "semiprivate" and 
"semipublic" to "public." This 
arrangement — a space hierarchy — allows 
movement from such public spaces as 
the street or sidewalk into such semi- 
public spaces as the front walk and front 
porch, and then into semiprivate (entry 
vestibule and living room) and private 
spaces (bedroom and bathroom). 

Elderly facilities that do not have the 
elements of a traditional space hierarchy 
can confuse older residents; they may 
not know what behavior is appropriate 
to a particular space. In a nursing home, 
for example, the "entry vestibule," "liv- 
ing room" and "bedroom" spaces nor- 
mally found in housing may all be pro- 



vided within one room, with no physical 
or visual barrier to separate the different 
levels of use; thus, a stranger can walk 
from the public "street" (the corridor) 
directly into the private bedroom. Some 
congregate housing and some residential 
care facilities pose similar problems. 

The architect can mitigate the lack of a 
traditional space hierarchy by recreating 
a front porch and entry vestibule with an 
alcove and a decorating concept, as well 
as by using privacy screens. Many of the 
other interior elements that help identify 
and protect different levels of privacy 
can also be included by the architect. 

Also see Alcoves, Community Spaces, 
Congregate Housing, Control, Resi- 
dents' Rooms and Residential Care 
Facilities and Nursing Homes in Part 
II: Facility Types. 

STAIRS 

Stairs and stepdowns pose potential 
hazards to people with visual impair- 
ments as well as to those who have diffi- 
culty walking. Different colors and sur- 
faces should be used to differentiate 
tread edges. Risers and treads of con- 
trasting colors are particularly helpful to 
the visually impaired, although patterns 
with a hypnotic effect should be avoided. 
Toe guards (without nosing) and side 
curbs are also essential safety aids, as are 
handrails (see ANSI A117.1 or the 
applicable barrier free design standards). 

Perception difficulties and reduced stam- 
ina among the elderly make it important 



140 III 



Stairs 



to provide at least three but no more 
than 10 risers of uniform height per 
flight. Studies have shown that a high 
percentage of the falls that occur within 
the elderly 's own residences can be 
traced to a single riser whose height is 
different from the other uniform riser 
heights on the stair. This problem is 
common in builders' houses with prefab- 
ricated stairs (see Safety). Stairs should 
be designed with runs that are as straight 
and as short as possible. If a stair is 
enclosed, it should be lighted to a higher 
intensity than normal, day and night. 

Consider providing seats on top, bottom 
and intermediate landings to enable 
users to rest and regain strength in the 
midst of a strenuous climb or descent. 
This feature can be particularly attrac- 
tive on open stairways leading to congre- 
gate facilities, offering both rest and 
preview opportunities. 

Also see Barrier-Free Design, Hand- 
rails and refer to barrier-free design 
standards. 

STORAGE 

Dwelling units for the elderly require 
long-term storage space for items that 
are not used on a daily basis. Space can 
be provided within the unit, on a bal- 
cony or patio outside the unit or in a 
central, convenient location in the build- 
ing. Interstitial spaces between rooms 
can also be used for storage of unused 
wheelchairs, seasonal clothing and 
artifacts. 

In nursing homes, space should be pro- 
vided outside residents' rooms for facil- 



ity-provided furniture not being used by 
the residents. Access should not require 
removal of stored items. When located 
outside a living unit, personal storage 
space should be lockable and visually 
observable before entry. Adequate stor- 
age and holding space for supplies, med- 
ical equipment, wheelchairs, walkers and 
stretchers must also be provided to 
ensure that corridors will not be 
obstructed by these items. 

In elderly housing, provide a minimum 
of 1 2 square feet of floor storage area or 
1 00 cubic feet of storage volume for each 
dwelling unit, in addition to the more 
frequently accessed storage areas — the 
standard size guest closet, utility closet, 
linen closet and wardrobe closet that 
should be provided in each dwelling unit. 

Avoid stacked storage units or other 
arrangements that require stooping or 
reaching. Provide lighting for storage 
areas and specify surface treatments that 
are easily maintained. Avoid exposed, 
untreated concrete, which is dusty and 
difficult to maintain. 

Also see Arts and Crafts Areas, Kit- 
chens, Residents' Rooms, Elderly 
Housing and Nursing Homes in Part 
II: Facility Types. 

SUN ROOMS 

A sun room can provide an excellent 
"outdoor" opportunity for the older per- 
son who has been confined indoors for a 
long period of time. With a good south- 
ern exposure, a sun room can provide 
the warmth of the sun and the changing 
light of the day — positive experiences for 
people of any age. 



Ill 141 



Therapy Rooms 



A sun room can be a high-glare environ- 
ment, which can make it difficult for an 
older person to perform tasks that 
require fine visual discrimination; for the 
same reason, the sun room is not a good 
place for television viewing or for game 
and assembly activities. Nor should the 
best views — usually of outside activity 
rather than pastoral scenes — be reserved 
for the sun room; glare may make watch- 
ing difficult. Sun control shades or blinds 
should be provided to maximize utiliza- 
tion of this space. 

Also see Activity Areas, Balconies, 
Outdoor Access and Site Development. 

TACTILE CUES 

Tactile cues are differentiations in tex- 
ture used to alert visually impaired 
people to such potential hazards as floor- 
level changes, stairways and the approach 
of a pedestrian walk or intersecting 
vehicular traffic. They can also be util- 
ized in the design of handles and levers, 
as well as controls for appliances and fix- 
tures. Tactile cues can also reinforce the 
visual or aural messages received by cog- 
nitively impaired individuals, and take 
varying forms — raised grooves, exposed 
aggregate concrete and rubber strips are 
all examples. 

A change in the surface texture of a 
handrail can be used to warn that a 
ramp is about to begin or end. Such tac- 
tile cues must be used consistently to be 
effective, and the generally lower tactile 
sensitivity of older people's fingers and 
hands require gross, rather than fine, 
differences in texture to ensure effective 
tactile cues. 



Also see Redundant Cueing, Stairs and 
refer to barrier-free design standards. 

TELEVISION VIEWING AREAS 

Television watching is a major activity 
for many older people. Televisions are 
usually located in private living rooms 
(and often in bedrooms too) and com- 
mon lounges. Television antenna outlet 
locations in these rooms often determine 
entire furniture layouts. Therefore, an 
outlet (or better, two or more) should be 
located to allow furniture arrangments 
that work for television viewing as well 
as for other activities. The television 
screen should also be located in a glare- 
free position — neither in front of win- 
dows, nor where it will reflect window 
images. 

Also see Activity Areas, Bedrooms, 
Living/Dining Room, Lounges and 
Residents' Rooms. 

THERAPY ROOMS 

Therapy rooms are utilized in nursing 
homes to help restore lost functional 
abilities and to stimulate the regenera- 
tion of tissue and organ systems. Hydro- 
therapy, physical therapy and occupa- 
tional therapy are all practiced in nurs- 
ing homes. 

Hydrotherapy may occur in the central 
bathing area, in special institutional tubs 
fitted with water jets, but is usually 
made part of a specific physical and 
hydrotherapy area. Some facilities may 
incorporate more-elaborate pools for 
patient treatments involving both 
therapist- and patient-immersion. 



142 III 



Therapy Rooms 



Physical therapy is often conducted in a 
separate room outfitted with special exer- 
cise equipment. This frequently under- 
utilized room should be prominently 
located and accessible to the nursing 
unit, where its use can be promoted. 
The ambience in a physical therapy 
room should not be biomechanical or 
prosthetic, but suggest and promote 
activity and involvement. 

Occupational therapy in the nursing 
home often takes the form of group 
activity focused on improving manipula- 
tive skills and hand-eye coordination. 
Occupational therapy requires space for 
the storage of supplies and of nearly- 
finished or finished products that will go 
on display. When special occupational 
therapy equipment is not required, gen- 
eral activity areas can be utilized for 
these therapeutic activities. 

Also see Nursing Care, and Nursing 
Homes in Part II: Facility Types. 

TOILET ROOMS 

The variety of toilet rooms provided in 
facilities for older users includes residen- 
tial bathrooms, nursing home residents' 
private toilet rooms, nursing home 
assisted toilet rooms (or "training toilet 
rooms") and, in all types of specially 
designed facilities as well as in buildings 
used by the general public, public toilet 
rooms. See Bathrooms for a discussion 
of residential private toilet rooms. All 
toilet rooms should be mechanically ven- 
tilated and have mechanical exhausts. 
Air-transfer grilles should not be used. 



Nursing home residents' private toilet 

rooms should each (optimally) serve only 
one private resident's room; where 
shared facilities and spaces are necessary, 
it is better to preserve privacy in the 
residents' rooms and provide for shared 
toilet rooms. Shared toilet rooms should 
never serve more than two residents' 
rooms or more than four beds. Provide 
an isolated space with direct access from 
the resident's room; the space should 
contain a lavatory (with mirror and 
storage) and a toilet (see Bathrooms for 
a discussion of toilet fixture selection). 
Private residents' rooms should be pro- 
vided with combination toilet-bathrooms, 
containing shower or tub/shower (see the 
discussion of tubs and showers under 
Bathrooms). Wherever tubs or showers 
are provided in a nursing home, bathing 
assistance will be required. Avoid 
locating lavatories in a resident's room 
itself whenever possible, to provide a 
measure of privacy. 

Provide space and clearance for wheel- 
chair access to the toilet room and its 
fixtures, and for nursing staff assistance 
(also see ANSI A117.1 or the applicable 
barrier-free design standard). Doors 
should have minimum clear widths of 2 
feet 8 inches, and permit emergency 
access from the outside either by swing- 
ing outward or with hardware that 
allows doors to swing outward in an 
emergency. Mirrors should be arranged 
for convenient use by both wheelchair- 
bound and standing residents; canted 
mirrors can be disorienting and are not 
recommended. 



Ill 143 



Uniform Federal Accessibility Standards 
(UFAS) 



Provide ready-access storage for wash- 
cloths, soap, toothbrushes, and other 
toileting and grooming items, and closed 
storage for bottles, tubes, jars and 
similar objects. Shared toilet rooms 
should be larger than private toilet 
rooms, and should provide separate 
storage for each resident. 

Water closets (see the discussion under 
Bathrooms) should be standard height 
(15 inches to the top of the seat) and the 
flushing mechanism should be easy to 
use by the resident. Provide grab bars at 
all water closets (see ANSI Al 17.1 or 
the applicable barrier-free design stand- 
ards), as well as toilet seat covers. Locate 
mirrors where they will enable use of the 
water closet as a seat and as a site for 
grooming activities. 

Properly located wall-mounted grab bars 
are more useful than fixture-mounted 
arms (which resemble the arms of a 
chair) for assisting a resident on and off 
the toilet; however, the wall next to the 
toilet must not be too far away to make 
a wall-mounted grab bar useful. 

Toilet room floors should be nonslip. 
Wall finishes should be washable and 
moisture resistant in fixture areas. Ceil- 
ings should be at least 7 feet 8 inches 
high and easily cleanable. Provide ade- 
quate lighting levels and high contrast 
for changes in surface. Control reflec- 
tions and glare. 

Nursing home attended toilet rooms 

should include all of the features of a 
resident's private toilet room, except 



storage, plus space for nursing assistance 
and for transferring to and from a 
wheelchair on both sides of the toilet. 
The attended toilet room should be adja- 
cent to the central bathing area. 

Public toilet rooms should be located 
near activity areas and lounges. Public 
toilets should be accessible to and usable 
by the handicapped (see ANSI Al 17.1 
or the applicable barrier-free design 
standards) and include all of the features 
of the resident's private toilet, except 
bathing fixtures and storage. Provide 
paper towel dispensers in addition. 

Also see Barrier-Free Design, Bath- 
rooms, Dining Areas, Doors, Lighting, 
Lounges, Residents' Rooms and refer 
to barrier-free design standards. 

UNIFORM FEDERAL 
ACCESSIBILITY STANDARDS 

(UFAS) 

The Uniform Federal Accessibility 
Standards (UFAS), published in August 
1984, constitute the sole accessibility standard 
referenced by the federal government for com- 
pliance with the Architectural Barriers 
Act of 1968. Thus, UFAS is now the 
federal standard for design, construction 
and alteration of facilities subject to the 
Barriers Act. In addition, the U.S. 
Department of Housing and Urban 
Development has proposed revising the 
Minimum Property Standards to refer- 
ence UFAS instead of ANSI A117.1, 
and the U.S. Department of Justice is 
encouraging the application of UFAS in 
the regulations implementing Section 
504 of the Rehabilitation Act of 1973. 



144 III 



Uniform Federal Accessibility Standards 

(UFAS) 



This new standard is based upon ANSI 
Al 17.1 (1980) and utilizes the same for- 
mat and similar illustrations. Text that is 
different from ANSI is underlined in 
UFAS; tables and illustrations (and por- 
tions thereof) that are different from 
ANSI are italicized. 

Overall, UFAS standards do not vary 
greatly from ANSI A117.1. The chief 
differences are as follows: 

• Extensive scope provisions are stated for 
all buildings funded or owned by the 
federal government. 

• UFAS contains accessibility standards 
for building types not covered by 
ANSI, including restaurant and 
cafeteria, health care, mercantile, 
library, and postal facilities. 

• Accessible dwelling units may be 
designed for either permanent accessi- 
bility or adaptability. 

Also see Adaptability, ANSI A117.1 
and Barrier-Free Design. 

VIGIL/VISITATION ROOM 

In a nursing home, it can be helpful to 
provide a small, quiet room off the nurs- 
ing station for agitated residents or for 
residents who wish to have private dis- 
cussions with family members or others. 
Such a room can also provide a private 
space for family members when a resi- 
dent is in critical condition. 

Also see Nursing Homes in Part II: 
Facility Types. 



WAYFINDING 

Age-related changes in sensory and cog- 
nitive abilities, as well as the loss of 
short-term memory, contribute to the 
difficulty some older people have with 
knowing where they are, and where they 
want to go and how to get there. The 
physical environment can add to this 
"disorientation" when it presents com- 
plex routes through buildings lined with 
repetitive architectural elements, fixtures 




The overall "footprint" of a facility can 
either help or hinder older people in finding 
their way. Simple, straight-forward building 
plans, rectilinear organizations with nodes, 
and views to the outdoors all help. Circles 
and other curvilinear plans can disorient. 



Ill 145 



Windows 



and finishes. Among the worst interior 
designs for orientation are long sequences 
of undifferentiated repetitive elements, or 
mazes and circles that don't quickly 
inform one of a wrong turn already 
made. Obscure or unreadable signs also 
contribute to disorientation among older 
building users. 

A key objective in design for aging is to 
enable elderly people to read their sur- 
roundings at any point on a site or in a 
building, thus allowing them to know 
where they are and, if they are going 
somewhere, make the appropriate deci- 
sions about how to reach their 
destination. 

Views to the outside provide a principal 
architectural (and psychological) mode of 
orientation relative to interior circulation 
systems. These cues to location (as well 
as to time of day and weather conditions) 
should be to the side of the path and not 
at ends of corridors, where they can 
create glare and confusion. Creating 
small seating areas in alcoves with win- 
dows to the outside can enhance the 
experience potential (and the use) of 
interior corridors. 

A simple, straightforward building plan 
of right angles minimizes many of the 
orientation problems that result from cir- 
cular-plan buildings and from encounters 
with multiple obtuse angles. Readable 
map and sign systems should be pro- 
vided, along with such other orienting 
devices as redundant cueing, landmarks, 
"neighborhood" decorating schemes, 



personalizable "porches" and doorways, 
and changes in illumination levels, floor 
surfaces, sounds and smells. 

Landmarks are physical features of the 
environment that stand out and are 
memorable. Landmarks aid wayfinding 
in and around buildings by helping users 
to know where they are and to decide 
how to reach their destinations. Water 
features, artwork, decorating schemes 
and dramatic spatial changes often serve 
as landmarks within buildings. 

Also see Corridors, Redundant Cueing, 
Sign Systems and Site Development. 

WHEELCHAIR ACCESSIBILITY 

Wheelchair users must also be accommo- 
dated in terms of accessibility to tables, 
counters and building controls. 

Also see Barrier-Free Design, Bath- 
rooms, Ramps, Site Development, 
Stairs and refer to barrier-free design 
standards. 

WINDOWS 

Many elderly people need a high level of 
illumination that is free of painful, dis- 
tracting glare. Minimize daylight glare 
by using light colors around windows, 
providing blinds, shades or curtains and 
avoiding the use of windows across the 
ends of corridors and hallways. 

Provide low sills (15 to 20 inches above 
the floor) for living/dining room and 
bedroom windows, to allow seated or 
bedridden people to see outside. When 



146 III 



Windows 




Windows provide view, illumination, and a connection to the outdoors. 



low sills are used — particularly in high- 
rise buildings — install sturdy mullions 
or guardrails to ensure safety and instill 
a sense of security. Locate mullions so 
that they do not obscure the views of 
older occupants, particularly at seated 
eye-level. Ground- floor windows that 
create exposure to passers-by require 
special design attention to provide for 



both outdoor views and security. Provide 
interior window sills that are wide 
enough to accommodate potted plants. 

In a given space, provide a minimum 
window area of 1 5 percent of the room 
floor area for natural lighting. The oper- 
able window area required for natural 
ventilation in dwelling units is five per- 



Ill 147 



Worship and Meditation Room 



cent of the floor area. Because the elder- 
ly are particularly vulnerable to drafts, 
do not introduce fresh air directly across 
sitting areas, or in a way that it cannot 
be quickly brought to room temperature. 
Do not rely on sliding doors or windows 
as the sole sources of fresh air, because 
of the possibility of floor-level drafts. 

Provide window-opening mechanisms 
that are easy to operate by the physically 
handicapped. Mount operable parts 30 
to 48 inches above the floor for easy 
access. 

Also see ANSI A117.1 or the applicable 
barrier- free design standards, Architec- 
tural Hardware, Barrier Free Design, 
Bedrooms, Corridors, Lighting, Out- 
door Access, and specific rooms or 
spaces. 



WORSHIP AND MEDITATION 
ROOM 

The worship and meditation room can 
provide a place for facility residents, 
their families and their friends to with- 
draw momentarily from worldly activi- 
ties and concerns, and to focus on their 
religious beliefs or contemplative prac- 
tices. In facilities for aging, the worship 
and meditation room is usually designed 
for individuals and groups of 4 to 6 peo- 
ple, rather than for organized worship. 
This may not be true, however, for 
facilities sponsored by religious organ- 
izations that may call for such uses as 
organized chapel services. 

Also see Activity Areas. 



APPENDICES 149 



APPENDIX A: 



Selected Annotated Bibliography 



Following a review of literature on 
design for the aging, the following 
references have been selected for inclu- 
sion in an annotated bibliography. Selec- 
tions are representative of information 
available covering a broad spectrum of 
design considerations. An additional set 
of unannotated references has been com- 
piled for further research. 

The annotated bibliographic information 
is presented followed by a notation on 
the availability of the reference. All 
references are available from the AIA 
Information Center by loan to AIA 
members and their employees. The 
Information Center is open to the public 
for reference use. Notation is made if the 
book can be purchased through the AIA 
Bookstore. Some references can be 
obtained from associations listed at the 
end of the bibliography. Unless noted as 
being out of publication, references can 
be ordered from the publisher. 

The Information Center is located in 
AIA Headquarters, 1735 New York 
Avenue, N.W. Washington, D.C. 
20006. The AIA Bookstore is located at 
the same address. 

American National Standards Insti- 
tute. American National Standard Specifica- 
tions for Making Buildings and Facilities 
Accessible to and Usable by the Physically 
Handicapped. New York: ANSI, All. 71, 
1980, 68 pages. Available: AIA Infor- 
mation Center: AIA Bookstore; AARP; 
NCOA; USGPO; HUD 

Standards presented are intended to 
make public facilities and residences 



accessible to and usable by people with 
walking inabilities or difficulties, for 
those who rely on walking aids, or those 
with hearing or visual disabilities, 
incoordination, reaching and manipula- 
tion disabilities, lack of stamina, diffi- 
culty interpreting and reacting to sensory 
information, and extremes of physical 
size. The standard applies to the design 
and construction of new buildings and 
facilities, site improvements, and public 
walks, the remodeling, alteration, and 
rehabilitation of existing construction, 
and permanent, temporary, and 
emergency conditions. Most standards 
are presented graphically as well as 
verbally. 

Architectural & Transportation Bar- 
riers Compliance Board. "Minimum 
Guidelines and Requirements for 
Accessible Design," Federal Register, 
47(150) August 4, 1982, 33 pages. 
Available: AIA Information Center; 
ATBCB 

This publication presents accessibility 
guidelines and requirements for build- 
ings funded, guaranteed or used by 
HUD, the Department of Defense, the 
U.S. Postal Service, and the General 
Services Administration. Standards have 
been revised to be more cost effective 
and consistent with Federal and nation- 
ally recognized guidelines while still pro- 
viding ready access and use. ANSI stan- 
dards are referenced and applied when 
appropriate. General building consider- 
ations, the scope of buildings covered, 
and technical provisions are included in 
the guidelines. Detailed graphics are 
included. 



150 APPENDICES 



Bibliography 



Aranyi, Lazlo and Goldman, Larry L. 

Design of Long-term Care Facilities. New- 
York: Van Nostrand Reinhold, 1980, 
210 pages. Available: AIA Information 
Center; AARP; NCOA; Publisher 

Information is provided on starting, 
designing, and running an institution 
best serving the needs of the elderly. The 
first sections of the book give special 
attention to financing when starting an 
institution. Space planning, color, odor 
control, lighting, security and acoustics 
are some of the many design areas 
specifically covered. Photographs and 
floor plans are included. 

Byerts, T.O. & Taylor, P.S. (eds.). 
"Curriculum Development in Envi- 
ronments and Aging." Journal of Archi- 
tectural Education, 1977 31(1), 48 pages, 
(entire issue) Available: AIA Informa- 
tion Center 

This entire issue of the JAE reports on a 
two-year program on curriculum devel- 
opment by The Gerontological Society of 
America aimed at developing a short- 
term understanding and a long-term 
perspective among students, educators, 
and practitioners relating to design for 
the elderly. The first section of the issue 
presents background content and detail 
useful to programming, design and eval- 
uation of facilities for the aging. The sec- 
ond section highlights reports of exper- 
ience gained in testing teaching materials 
and developing course directions 
including course content in several 
design schools across the country. 



Byerts, T.O., Howell, S.C., Pastalan, 

L.A. (eds.). Environmental Context of 
Aging: Life Styles, Environmental Quality, 
and Living Arrangements. New York: 
Garland STPM Press, 1979. Available: 
AARP; AIA Information Center; 
Publisher. 

This book is comprised of three major 
sections dealing with the effects of the 
environment on people during the aging 
process. Each section focuses on specific 
topics: 1) how the elderly live, what we 
know and need to know; 2) negotiating 
the environment; and 3) specialized 
environments. Each topic contains arti- 
cles important to services and housing in 
the aging field. The material is based on 
The Gerontological Society of America's 
environment and aging program inte- 
grating the results of seven years of 
research. 

Currie, Leonard, and others. Designing 
Environments for the Aging: Policies and 
Strategies. Urbana-Champaign: Univer- 
sity of Illinois, 1977, 104 pages. 

Available: AIA Information Center; 
Publisher 

A collection of articles prepared by the 
Jane Addams College of Social Work 
and College of Art, Architecture and 
Urban Sciences of the University of 
Illinois at Chicago Circle, the book 
covers a wide range of topics relating to 
design for the elderly. Starting with 
background information on the general 
problems of aging, the book progresses 
to social considerations of aging, to 
barrier-free environments for the 



APPENDICES 151 



Bibliography 



handicapped-many of whom are elderly, 
and to an abbreviated form of planning 
a skilled nursing facility including 
examples of student projects. Section V 
concerns the need for and feasibility of 
congregate housing followed by a pro- 
posed plan for a congregate facility. Sec- 
tion VI is on planning for the reuse of 
unused facilities of the Chicago Tubercu- 
losis Sanitarium for housing for the 
elderly. A description of the program, 
and the opportunities and potential 
economics afforded by adaptive reuse is 
presented along with part of a solution 
proposed by a team of two students. 
Section VII summarizes the experience 
of a group of architectural students who 
visited a variety of housing and health 
care facilities for the elderly, gathered 
data, and undertook individual projects 
for planning and design of several dif- 
ferent types of facilities in different 
localities. Section VIII highlights some of 
the experiences of other countries in pro- 
viding for the aging. The final section 
treats energy conservation and the 
elderly. 

Federal National Mortgage Associa- 
tion. Forum III: Housing for the Retired. 
Washington, D.C.; author, 1979, 48 
pages. Available: AIA Information 
Center; AARP 

Forum III was made up of 120 people, 
selected to represent a cross-section of 
the national retiree population, who 
attended a symposium in Washington, 
D.C. The purpose of the forum was to 
learn directly from middle-income retired 
people more about the human motivia- 



tions and other factors affecting their 
housing decisions. Changing life styles 
and social patterns, economic factors 
affecting retirement housing, and design 
discussions of housing for the elderly 
were included on the agenda. Based on 
responses to 1,350 questionnaires sent to 
retirees prior to the forum relating to 
their housing needs, the "Options" 
house was designed. Its flexibility affords 
the opportunity to satisfy many indi- 
vidual needs and preferences; several 
examples of this are included in the case 
study. 

Gelwicks, Louis E. & Newcomer, 
Robert J. Planning Housing Environments 
for the Elderly. Washington, D.C: 
National Council on the Aging, 1974, 
120 pages. Available: AIA Information 
Center; NCOA; Publisher. 

This text provides the reader with 
theoretical backgrounds as well as prac- 
tical implications and applications for 
design. Chapter titles include: Demo- 
graphic and Policy Trends; Environment 
and the Elderly; Coping With the Envi- 
ronment: Competence, Need and Satis- 
faction; and Planning for the Future. 
Even though this book has been in pub- 
lication since 1974, the information is 
appropriate to the design process today. 

General Services Administration, 
Department of Defense, Department of 
Housing and Urban Development, 
and U.S. Postal Service. Uniform Federal 
Accessibility Standards. Federal Register, 
Vol. 49 No. 153). Washington, D.C: 
Federal Register, 1984. Available: AIA 
Information Center, GSA, DOD, HUD, 
USPS. 



152 APPENDICES 



Bibliography 



This document presents uniform stan- 
dards for the design, construction and 
alteration of buildings so that physically 
handicapped persons will have ready 
access and use of them. UFAS is based 
upon ANSI A117.1 (1980) and utilizes 
the same format and illustrations. Text 
that is different from ANSI is underlined 
in UFAS; tables and illustration (and 
portions thereof) that are different from 
ANSI are italicized. 

Harkness, Sarah P. and Groom, James 

N. Jr. Building without Barriers for the 
Disabled. New York: Watson-Guptill 
Publications, 1976, 79 pages. 

Available: Information Center; Publisher 

The handbook begins with a discussion 
of the needs associated with various 
disabilities including those of the blind, 
deaf, and the manipulatory-, ambulant-, 
and chairbound-disabled. Included is 
information on signs, sounds, signals; 
type and surface of handrails; angles of 
ramps and walks; areas of reach; and 
wheelchair transfer space. Section Two 
relates to architectural planning, cover- 
ing such areas as site development and 
the interior planning of corridors, doors, 
bathrooms, and kitchens. The book is 
thoroughly illustrated with drawings, 
diagrams and photographs and includes 
a chart comparing recommended dimen- 
sions for different architectural elements 
compiled from 14 sources. 



Hoglund, J. David. The Intangible 
Qualities of Housing. J. David Hoglund, 
1983, 118 pages. Available: AIA Infor- 
mation Center; available from author 

Based on his travels in Europe, the 
author has concluded that Europeans are 
"far ahead of the United States in their 
concerns for such social issues as inde- 
pendence and privacy." Chapter 1 
focuses on the difficulty that design pro- 
fessionals have in translating social/ 
behavioral goals into a design vocabu- 
lary. Arbitrarily applied accessibility 
standards are not always appropriate to 
the daily needs of the elderly. Chapter 2 
is an overview of the aging process. 
Chapter 3 establishes a conceptual 
framework of the relationship between 
privacy and independence and their 
influence on the individual. The provi- 
sion of housing care in Sweden, Den- 
mark and Great Britain are analyzed in 
Chapters 4-6. Current themes and future 
directions in housing for the elderly are 
discussed in Chapter 7. Case studies of 
16 buildings are illustrated with 
photographs and drawings and a verbal 
description and commentary. Several of 
these projects are designed to allow for 
multiple levels of care within one 
building. The publication received an 
award from Progressive Architecture. 



APPENDICES 153 



Bibliography 



Howell, Sandra C. Designing for Aging: 
Patterns of Use. Cambridge, MA: MIT 
Press, 1980, 329 pages. Available: AIA 
Information Center: AIA Bookstore; 
AARP; Publisher 

Responses from a large national FHA 
sample of residents living in apartment 
buildings across the United States that 
conform to government standards were 
analyzed as a basis for this book. In 
addition, an in-depth analysis of careful- 
ly selected specific spaces and their use 
by tenants was conducted on sites in 
Cambridge, Massachusetts. Howell notes 
"the most important point this material 
should convey is that older people need 
variations in the space in which they 
live. This can be accomplished with 
careful spatial definition." The book is 
organized into six major sections. 
Chapter 1 attempts to place the residen- 
tial aspects of American aging in the 
meaning of "habitat." Chapter 2 is an 
extension of design and aging into pro- 
duction, program, and practice and their 
influence on new living environments. 
Chapter 3 details the methodology of the 
study. Chapters 4 and 5 are intended to 
be a user's manual for programming 
and design review of housing for some 
aggregations of aging people. Chapter 6 
is a summary and a discussion of future 
directions for collaborative work in 
designing for habitability across the 
human life cycle. Included are numerous 
photographs, drawings, and floorplans. 



Jordan, Joe J. Senior Center Design: An 
Architect's Discussion of Facility Planning. 
Washington, D.C.: National Council 
on Aging, 1978, 104 pages. Available: 
AIA Information Center; NCOA 

A design manual for planning senior 
centers, this book is addressed to archi- 
tects and design professionals, funding 
agency personnel, board members and 
staff, providing technical assistance to 
anyone providing a facility to accom- 
modate senior citizens. Planning issues 
of concern to the sponsoring agencies are 
covered in the early chapters, while the 
later ones deal with issues of space plan- 
ning essential to the architect. Typical 
activities that might be expected to occur 
in a senior center, characteristics of the 
elederly affecting design decisions, and 
planning the space to create the opti- 
mum environment are discussed. 
Included are 37 checklists for design of 
various areas, rooms, systems, and activ- 
ities along with reference charts of space 
required for specific areas. 

Jordan, Joe J. "Recognizing and 
Designing for the Subtle and Special 
Needs of the Elderly." AIA Journal, 
1977, September, pages 50-55. 

Available: AIA Information Center. 

The author cites the importance of 
design features which keep in mind that 
older people as individuals possess "an 
even greater diversity in terms of health, 
personality, intellect, and overall compe- 
tence than other segments of society." 
Based on this assertion, several design 



154 APPENDICES 



Bibliography 



goals are outlined as being applicable to 
any congregate facility, nursing home, 
domiciliary housing, day care center, 
and retirement community. Three 
facilities, the Dayton, Ohio Senior 
Citizens' Center, the Philadelphia Cen- 
ter for Old People, and the Waxter Cen- 
ter for Old People in Baltimore, are 
evaluated by the author in terms of 
meeting design goals. Ways in which the 
facilities could better meet the needs of 
older adults are discussed. 

Koncelik, J. A. Aging and the Product 
Environment. Stroudsburg: Dowden, 
Hutchinson & Ross, 1982, 201 pages. 

Available: AIA Information Center; 
AARP; Publisher 

The author suggests that environments 
and products created for the elderly are 
largely inadequate and do not reflect 
user conditions and requirements. Speci- 
fic suggestions for the design of rooms, 
furniture, fixtures, appliances, vehicles 
and other products used by the elderly 
are presented. 

Koncelik, J. A. Designing the Open Nursing 
Home. Stroudsburg: Dowden, Hutchin- 
son & Ross, 1976, 175 pages. 

Available: AIA Information Center; AIA 
Bookstore; AARP; NCOA; Publisher 

The purpose of the text is to provide 
designers, administrators, and others 
involved in the design of the actual liv- 
ing space of the patient-resident with 
readable, imageable, jargonless informa- 
tion on "the inhabitants and their prob- 



lems, the character of accessibility and 
possible alternatives for outfitting the 
interior environment." Although the 
book has been directed toward nursing 
homes, the information should prove 
helpful in planning any facility for the 
elderly. Background on the aging popu- 
lation is presented first and is followed 
by a section on planning. A large seg- 
ment of the book relates to the actual 
design of space and architectural details 
plus selection of furnishings and con- 
sumer products. 

Lawton, M. Powell. Community Planning 
for an Aging Society: Planning Services and 
Facilities. Stroudsburg: Dowden, 
Hutchinson & Ross, 1976, 340 pages. 
Available: AIA Information Center; 
AARP; Publisher 

Designed to stress the concept that phys- 
ical planning and social planning can 
work together to create a positive, sup- 
portive environment for the elderly, this 
book contains basic gerontological infor- 
mation. That knowledge is translated 
into social and environmental prescrip- 
tions, a number of applications of popu- 
lation data used in planning, and reports 
on some research methods. The collec- 
tion of papers is divided into four sec- 
tions. Part 1 provides basic facts about 
aging, highlighting planning related 
aspects. Part 2 presents a conceptualiz- 
ation of several issues in community 
planning and policy decisions affecting 
the life style of the older person. Part 3 
relates to programming aspects of hous- 
ing for the elderly, and examines issues 



APPENDICES 155 



Bibliography 



such as demand estimation, housing 
preferences and satisfaction, and site- 
selection criteria. Part 4 considers com- 
munity service for the elderly presented 
within the context of a social planning 
process. 

Lawton, M. Powell. Environment and 
Aging. Monterey, CA: Brooks/Cole 
Publishing Co, 1980, 186 pages. 

Available: AIA Information Center; 
AARP; HUD; Out of Print 

The framework of the book is called an 
"ecological model of adaptation and 
aging"; and enables readers to view a 
variety of environmental situations and 
serves as examples of a more general 
phenomenon called "environmental 
press." It also discusses competence in 
adaptation. Details of how older people 
live in, enjoy, and cope with the stresses 
of community, neighborhood, the domi- 
cile, planned housing, institutions, 
mobility, and transportation are presen- 
ted. Chapter titles are: Environment in 
Human Behavior; Where Older People 
Live: The Macroenvironment; Where 
Older People Live: The Microenviron- 
ment; Planned Housing; Institutions for 
the Aged; Older People on the Move; 
and Conclusion: Increasing the Impact 
of Environmental Research. 



Lawton, M. Powell. Planning and 
Managing Housing for the Elderly. New 
York: Wiley-Interscience, 1975, 336 
pages. Available: AIA Information 
Center; Publisher 

This book is designed to provide 
assistance to both laymen and profes- 
sionals at various stages in the concep- 
tion, planning, and management of 
housing environments for older people. 
The first part of the text relates to back- 
ground on the elderly and housing. Part 
2 deals with the planning and design 
phase. Part 3 concerns management, 
tenants, and programs. The appendices 
include information on organizations 
with an interest in housing, references, a 
sample pre-occupancy medical examina- 
tion form, and a community survey of 
housing preferences. Photographs are 
included to illustrate socially positive 
environments. 

Raschko, Bettyann Boetticher. Housing 
Interiors for the Disabled and Elderly. New 
York: Van Nostrand & Reinhold, 
1982, 360 pages. Available: AIA Infor- 
mation Center; AIA Bookstore: AARP; 
NCOA; Publisher 

Subjects explored by the author include 
anthropometrics, spatial relationships, 
body mechanics, product design, secur- 
ity, furniture design, silent alarms, and 
mechanical systems. Selection and con- 
struction of furniture, furniture arrange- 
ments, floor coverings, and hardware 
illumination are discussed to show how 
rooms can be made more accessible. 
Included are many illustrations, charts, 
and drawings. 



156 APPENDICES 



Bibliography 



Sanoff, H., Adams, G., Andrews, R. 

& Walker, C. Senior Center Design 
Workbook. North Carolina State Uni- 
versity School of Design, 1979, 110 
pages. Available: AIA Information 
Center 

Participants in senior center programs, 
administrators and sponsors can use this 
workbook in the planning of senior cen- 
ters to select the appropriate features 
reflecting the unique characteristics of 
the community that will be served. The 
technique begins with an examination of 
the activity areas that may be included 
in a senior center and their constituent 
environmental settings. It then proceeds 
to determine the objectives, the activi- 
ties, the spatial layout, and the visual 
quality of the center through use of 
worksheets, floor plans, photographs, 
charts, and text. 

Sorenson, Robert James. Design for 
Accessibility. New York: McGraw Hill 
Book Co., 1979, 264 pages. Available: 
AIA Information Center; AIA 
Bookstore; Publisher 

Designed primarily for use by architects, 
the annotated drawings in this book 
illustrate design requirements for handi- 
capped access for both the interior and 
exterior areas of buildings. Building ele- 
ments are covered, from site design to 
selection of materials, hardware, and 
special appliances. The appendix pro- 
vides the text of basic federal laws and 
covers the status of state laws governing 
access requirements up to time of publi- 
cation. 



Steinfield, Edward Barrier-free Design for 
the Elderly and the Disabled. Syracuse, NY: 
Syracuse University, 1975. Available: 
AIA Information Center; AARP; Pub- 
lisher 

This is a self-instructural four-part learn- 
ing module prepared for practicing pro- 
fessionals interested in environments for 
the aged. Part 1 included definitions, 
discussion of important concepts, histor- 
ical background, and a bibliography. 
Part 2 is an audio-visual presentation of 
older persons' own observations about 
barriers in their environment. Part 3 is a 
workbook which includes presentations 
of anthropometric and other human fac- 
tors information, and a series of analysis 
problems designed for users of the mod- 
ule to instruct themselves about specific 
barrier-free design features. Part 4 pro- 
vides evaluation problems allowing users 
to choose the one best suited to their 
background and interest. 

Sumichrast, Michael and others. Plan- 
ning Your Retirement Housing. Glenview, 
111.; Scott Foresman & Co., 1984, 259 
pages. Available: AIA Information 
Center; AARP; Publisher 

Although written primarily to present 
housing options to the person who is 
considering retirement, this reference 
should prove helpful to the architect as 
well. Many special amenities and design 
features are described. Checklists, charts, 
tables, and annotated floor plans draw 
attention to the details to be considered 
when making a move. Included is infor- 
mation on renting or buying property 
along with descriptions of alternative liv- 



APPENDICES 157 



Bibliography 



ing environments such as mobile home 
parks, granny flats, co-ops or retirement 
communities. The renovation of present 
living space is also discussed. 

Urban Land Institute. Housing for a 
Maturing Population. Washington, D.C.: 
Urban Land Institue in cooperation 
with the Housing Committee, Ameri- 
can Institute of Architects, 1983, 246 
pages. Available: AIA Information 
Center; AIA Bookstore; AARP; NCOA 

Articles prepared for this book relate to 
planning for the full life cycle needs of a 
community and its residents. The book 
begins with a general discussion of dem- 
ographic and housing issues, followed by 
a review of design considerations. A 
detailed study of a variety of housing 
types and community alternatives are 
also included. Case examples concentrate 
on the needs of the majority of older 
persons and their adaptability to their 
living environment. 

Welch, P., Parker, V., and Zeisel, J. 

Independence Through Interdependence: Con- 
gregate Living for Older People. Boston, 
Massachusetts: Reprographics Inc., 
1984, 203 pages. Available: AIA Infor- 
mation Center; Office of Policy and 
Planning — Department of Elder Affairs, 
Boston, MA 

This book explains the many interrelated 
tasks involved in the development and 
operation of congregate housing. Feasi- 
bility analysis involves evaluating the 
congregate program's needs and resour- 
ces, establishing community support, 
and organizing the planning team. The 
planning phase of a congregate project 



includes programming, developing oper- 
ational procedures, designing and con- 
structing the facility, developing manage- 
ment and services, and marketing. The 
occupancy phase of the project relates to 
the creation and evaluation of a com- 
munity quality. Two appendices, photo- 
graphs, and floor plans are also 
included. 

Zeisel, J., and others. Low-rise Housing 
for Older People: Behaviorial Criteria for 
Design. Washington, D.C. USGPO, 
1978, 141 pages. Available: AIA Infor- 
mation Center; AARP; NCOA; HUD; 
USGPO 

Available research on the housing needs 
of older people is translated into perfor- 
mance criteria for designers. Information 
is divided into six categories: inside the 
housing unit; unit edge; places for inter- 
action with neighbors; community activ- 
ity; spaces on the site; and links to town. 
Each category has performance criteria, 
possible design solutions in both words 
and pictures, several annotated plans 
and a set of design review questions. Pro- 
gressive Architecture presented the report an 
award for being "the best single-volume 
summary of design and program guide- 
lines for low-rise housing for the 
elderly." 

Zeisel, J. and others. Mid-rise Elevator 
Housing for Older People: Behaviorial Criteria 
for Design. Washington, D.C: HUD, 
177 pages. Available: AIA Information 
Center; AARP; NCOA; HUD 

Mid-rise housing is defined as having 
more than 2 and less than 6 or 7 stories. 



158 APPENDICES 



Bibliography 



The text deals primarily with design 
questions arising after the basic building 
concept has been chosen, but before con- 
struction documents can be produced. 
Emphasis is on how the use of elevators 
changes the context of all other building 
elements. Zones, sites, entrances, entry 
lobby, community spaces, the elevator 
core, and passageways are given special 
attention. The appendix includes a list of 
1 20 questions relating to design of mid- 
rise housing that should be helpful to 
planners of such buildings. 

Design for Aging — Additional 
References 

Alexander, C, and others. A Pattern 
Language Which Generates Multi-Service 
Centers. Berkeley, CA: Center for Envi- 
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American Institute of Architects and 
the International Center for Social 
Gerontology. International Exhibition on 
Housing for Older Adults: Catalogue. 
Washington, D.C.: American Institute 
of Architects, 1973. 

American Nursing Home Association. 

Suggested Planning Guidelines for SNF/ICF 
Long-Term Care Facilities. Washington, 
D.C.: Author, 1974. 

American Society of Landscape Archi- 
tects Foundation. Barrier Free Site Design. 
Washington, D.C.: U.S. Department 
of Housing & Urban Development, 
1975. 



Barker, K.N. "These Guidelines Can 
Help in Design of Nurses' Stations." 

Modern Nursing Home, 1973 (March), 
30)30), page 14. 

Beyer, Glenn H. & Nierstrasz, F.H.J. 

Housing the Aged in Western Countries: Pro- 
grams, Dwellings, Homes and Geriatric Facil- 
ities. New York: Elsevier, 1967. 

Bobrow, M.L. "The Evolution of 
Nursing Space Planning for Efficient 
Operation . " A rchitectural Record. 1971 
(September). 

Byerts, T.& Conway, D. (eds.) 

Behavioral Requirements for Housing the 
Elderly. Report from a working confer- 
ence. Washington, D.C.; American 
Institute of Architects, Association for 
the study of Man-environment Rela- 
tions, Gerontological Society, and the 
National Tenants Organization, 1972. 

Byerts, T.O., Howell, S.C., Pastalan, 
L.A. (Eds.), Environmental Context of 
Aging: Life Styles, Environmental Quality, 
and Living Arrangements. New York: 
Garland STPM Press, 1979. 

Byerts, T.O. (ed.) "Symposium: The 
City: A Viable Environment for the 
Elderly?" The Gerontologist. 1975, Part 
1, pages 13-46. 

Carp, F.M. "Life Style and Location 
Within the City." The Gerontologist. 
1975, 15(1), pages 22-34. 



APPENDICES 159 



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Carp, F.M. "A Senior Center in 
Public Housing for the Elderly." The 
Gerontologist. 1976, 16(3), pages 
243-249. 

Carp, F.M. "User Evaluation of 
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Cavavaty, R.D. & Haviland, D.S. Life 
Safety from Fire: A Guide for Housing the 
Elderly. Washington, D.C.: Federal 
Housing Administration, USGPO, 
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Central Mortgage and Housing Corp. 

Housing the Elderly: Guide to Design. 2nd 
edition. Ottowa, Canada: Author, 
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Chapanis, A. "Human Engineering 
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Cheek, F.E., Maxwell, R. and 
Weisman, R. "Carpeting the Ward: 
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55, pages 109-118. 

Chellis, R.D., Seagle, J.F. & Seagle, 
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Colavita, F.B. Sensory Changes in the 
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Thomas, 1978. 



Cranz, Galen & Schumacher, Thomas 
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Cranz, Galen & Schumacher, Thomas 
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Diffrient, N., and others, Humanscale 
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Press, 1974, 1978 

Donahue, W.T., and others (eds) Con- 
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Need, a Growing Demand. Washington, 
D.C.: USGPO, 1977. 

Eisdorfer, C & Lawton, M.P. (eds) 

The Psychology of Adult Development and 
Aging. Washington, D.C.: American 
Psychological Association, 1973. 

Epp, G.T. "Communicating Research 
to Designers: A Study of Community 
Spaces in Residential Settings for the 
Elderly." Master's thesis, Department 
of Urban Studies & Planning, Massa- 
chusetts Institute of Technology, 1975. 



160 APPENDICES 



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Fodor, T. & Katoni, E. "Site Criteria 
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Fozard. J.L. "Person-Environment 
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Fozard, J.L. , and others. "Visual 
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Frush, James & Eschenbach, B. The 

Retirement Residence: An Analysis of the 
Architecture and Management of Life-Care 
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Gage-Babcock & Associates Fire Safety 
Manual for Nursing Homes. Washington, 
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Gerontological Planning Associates. An 
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First National Conference on Congre- 
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Gerontological Society & All Universi- 
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Harris, C.S. Fact Book on Aging: A Profile 
of America's Older Population. Washington, 
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Heintz, Katherine M. Retirement Com- 
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Hiatt, L.G. "Architecture for the 
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Hiatt, L.G. "Color and Care: The 
Selection and Use of Colors in Envi- 
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Hiatt, L.G. "Designing Therapeutic 
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Hiatt, L.G. "A Self-administered 
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pages 33-39. 

Howell, S.C. "The Elderly and the 
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1979, pages 412-419. Also Cambridge, 
MA: MIT Department of Architec- 
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Howell, S.C. Private Space: Habitability of 
Apartments for the Elderly. Cambridge, 
MA: MIT Department of Architec- 
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Howell, S.C. Shared Spaces in Housing for 
the Elderly. Cambridge, MA: MIT 
Department of Architecture, Design 
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APPENDICES 161 



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Howell, S.C. Storage: Putting Things 
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Howell, S.C. Windows. Cambridge, 
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Hughes, P.C. & Neer, R.M. 
"Lighting for the Elderly: A 
Psychological Approach to Lighting." 
Human Factors. 1980, 23, pages 65-86. 

Hunt, M.E., Feldt, A.G., Mararos, 
R.W., Pastalan, L.A., Volcalo, K.L. 

Retirement Communities: An American 
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1984. 

International Center for Social Geron- 
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Washington, D.C.: Author, 1981. 

Joint Commission on Accreditation of 
Hospitals. Accreditation Manual for Long- 
Term Care Facilities. Washington, D.C: 
American Hospital Association, 1977. 

Jordan, Joe J. "Facility Design: First, 
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Jordan, J.J. Senior Center Facilities: An 
Architect's Evaluation of Building Design, 
Equipment and Furnishings. Washington, 
D.C: National Council on the Aging, 
1975. 



Kira, A. The Bathroom: Criteria for Design. 
2nd Ed. Ithaca, NY: Cornell U. 
Center for Housing and Environmen- 
tal Studies, 1966: also New York: 
Viking, 1976. 

Lawton, M.P., Windley, P.G., and 
Byerts, T.O. (editors), Aging and the 
Environment: Directions and Perspectives. 
New York: Springer Press, 1982. 

Lawton, M.P. "The Human Being 
and the Institutiuonal Building." In 
J. Lang, Designing for Human Behavior: 
Architecture and the Behavior Sciences. 
Stroudsburg, PA: Dowden, Hutch- 
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Lawton, M.P. "The Impact of the 
Environment on Aging and Behavior" 
in J.E. Birren and K. Schaie (editors), 

Handbook of the Psychology of Aging, New 
York: Van Nostrand, 1977. 

Lawton, M.P. Planning and Managing 
Housing for the Elderly. New York: 
Wiley-Interscience, 1975. 

Lawton, M.P., Newcomer, R.J., & 
Byerts, T.O. (editors) Community Plan- 
ning for an Aging Society, Stroudsburg, 
PA: Dowden, Hutchinson & Ross, 
1976. 

Lefitt, J. "Lighting for the Elderly: 
An Optician's view." In R. 
Greenhalgh (ed.) Light for Low Vision. 
Proceedings of a Symposium, U. 
College, London, April, 1978. 



Kanaly, G. & Smith, M.C. "Nursing 
Attitudes Toward the Constructed 
Environment of Nursing Homes." 

Hospital & Health Services Administration, 
1982, Nov/Dec, pages 74-100. 



162 APPENDICES 



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Leib, R.K. "How to Buy Chairs." 

American Health Care Association Journal; 
1982 July), pages 21-24. 

Lerup, Lars. "What People Do in 
Nursing Home Fires." In David 
Greenwood & John S. Burke Recurrent 
Behavior Patterns in Institutional Buildings 
Under Fire: Ten Case Studies of Nursing 
Facilities. Washington, D.C.: USPHS 
(HEW-NBS Life/Fire Safety 
Program), 1976. 

Lifchez, R. & Winslow, B. Design for 
Independent Living: The Environment and 
Physically Disabled People. New York: 
Guptil (Whitney Library of Design), 
1979. 

Lipman, A. "Old People's Homes: 
Siting and Neighborhood 
Integration." The Sociological Review. 
1967, 15, pages 323-338. 

Malassigne, P.M. Design of Bathrooms, 
Bathroom Fixtures and Controls for the Abie- 
Bodied and Disabled: Annual Report 
1976-1977. Blacksburg, VA: Virginia 
Polytechnic Institute & State U., 
1977. 

Margulis, S.T. Building Accessibility in 
Relation to Door Hardware, Door Users, and 
Door Use. Washington, D.C.: U.S. 
Department of Commerce, National 
Bureau of Standards, 1981. 



McClannahan, L.E. "Therapeutic and 
Prosthetic Living Environments for 
Nursing Home Residents." The Geron- 
tologist. 1973, 13(4) pages 424-429. 

McGuire, M. Design of Housing for the 
Elderly. Washington, D.C: National 
Association of Housing & Redevelop- 
ment Officials, 1972. 

McGuire, Marie C. Housing for the 
Elderly: Architect's Checklist. Washington, 
D.C: U.S. Public Housing Adminis- 
tration, 1962. 

McRae, J. Elderly in the Environment: 
Northern Europe. Gainesville, FL: U. of 
Florida College of Architecture and 
Center for Gerontology Studies & Pro- 
grams, 1975. 

Michigan, University of, School of 
Art, Program in Industrial Design. 

Bathroom Facilities Accommodating the 
Physically Disabled and the Aged. Ann 
Arbor, MI: Author, 1977. 

Moos, R.H. & Lemke, S. "Assessing 
the Physical and Architectural 
Features of Sheltered Care Settings." 

Journal of Gerontology. 1980, 35(4), pages 
571-583. 

Moos, R.H. & Lemke, S. Multiphasic 
Environmental Assessment Procedure (MEAP): 
Preliminary Manual. Palo Alto, CA: Stan- 
ford University — VA Medical Center 
Social Ecology Laboratory, 1979. 

Musson, Noverre & Heusinkveld, 
Helen. Buildings for the Elderly. New York: 
Reinhold, 1963. 



APPENDICES 163 



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National Citizen's Coalition for Nurs- 
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on Quality Care. Washington, D.C.: 
NCCNHR, 1985. 

National Council on Aging: "The Sixth 
Sense, " film. New York: Dennis Knife 
Productions, 1985. 

Nierstrasz, Frits H.J. (ed.) Buildings for 
the Aged. New York: Elsevier, 1961. 

Obenland, R.J. Design Options for a Con- 
tinuum of Care Environment. Concord, 
NH: New England Non-Profit Hous- 
ing Development Corporation, 1976. 

Overstall, P.W. "Prevention of Falls 
in the Elderly." Journal of the American 
Geriatrics Society. 1980, 28(11), pages 
481-484. 

Palmore, E. "Advantages of Aging." 
The Gerontologist. 1979, 19(2), pages 
220-223. 

Parr, J. "The Interaction of Persons 
and Living Environments." In L. 
Poon (ed.) Aging in the 1980's. 
Washington, D.C.: American 
Psychological Association, 1980. 

Pastalan, L.A. & Carson, D.H. (eds.) 

Spatial Behavior of Older People. Ann 
Arbor, MI: The University of 
Michigan — Wayne State U. Institute 
of Gerontology, 1970. 

Pease, J. Furniture Selection for Older 
People. Falls Church, VA: Van Scoyoc 
Associates, 1980. 



Professional Nursing Home. "130 Common 
Mistakes in Nursing Home Planning 
and Design." 1968 (May), pages 
20-31. 

Regnier, V.A. ( Byerts, T.O. "Apply- 
ing Research to the Planning and 
Design of Housing for the Elderly." 
In F. Spinks (ed.) Housing for a Maturing 
Population. Washington, D.C.: Urban 
Land Institute, 1983. 

Regnier, V.A., & Gelwicks, L., 
"Assessment of Preferred Supportive 
Services for Middle and Higher 
Income Housing: Implications for 
Service Selection and Architectural 
Programming; The Gerontologist, (20), 1, 
1981. 

Regnier, V.A., Beverly Hills Congregate 
Residence Participatory Design and Planning 
Feasibility Analysis, Los Angeles, CA: U. 
of Southern California Press, 1979. 

Rutherford, Robert B. & Hoist, 
Arthur J. (eds.) Architectural Designs: 
Homes for the Aged, The European Approach. 
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164 APPENDICES 



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Sherwood, Sylvia and others. A Pilot 
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Highland Heights: A Functional Analysis. 
Washington, D.C.: American Institute 
of Architects, 1973. 

Sivak, M., and others. "Effect of 
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Steinfeld, E. Barrier- Free Design for the 
Elderly and the Disabled. Syracuse, NY: 
Syracuse University, 1975. 

Steinfeld, Edward; Brecher, Steward; 
Schubert, Ann; Gau Chyi-Jou. Senior 
Centers: A Renovation Manual, Harrisburg, 
Pennsylvania Senior Center Institute, 
January 1980. 

Steinfeld, Edward, Series on Barrier- 
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March 1979, pp 69-71; May 1979, pp 
69-73; July 1979, pp 65-67; October 
1979, pp 57-59; March 1980, pp. 
57-65; August 1980, pp. 51-59. 

Stolper, Jane H. "Environmental 
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Struyk, Raymond J. & Zais, James P. 

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Syracuse University All-University 
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Urban Research and Development 
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Wilner, M.A., and others (eds.) Plan- 
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Demos, 1975. 



APPENDICES 167 



APPENDIX B: 



Design for Aging Information Network 



This appendix lists the Keywords which 
access the Design for Aging Information 
Database. 

If any of the Keywords are of particular 
interest, pertinent references may be 
obtained by sending a request for a com- 
puter search — combinations of 2 to 4 
keywords — to: 

AIA Information Center 
1735 New York Ave, N.W. 
Washington, DC 20006 

or call: (202) 626-7493 

(There will be a minimal charge for the 
computer search.) 

AARP 

ACCESSIBILITY 

ACCESSORY APARTMENTS 

ACOUSTICS 

ACTIVITY AREA 

ADMINISTRATION 

AGENCIES 

AGING 

AIA 

AIDS & ASSISTIVE DEVICES 

ALARMS 

ALZHEIMERS 

ANSI 

ANTHROPOMETRICS 

APARTMENTS 

ARCHITECT 

ARCHITECTURE 

ARTS 

ATRIUM 

AUDITORY IMPAIRMENT 

AUTHOR 

BATHROOM 

BEDROOM 

BEHAVIORAL REQUIREMENTS 



BIBLIOGRAPHY 

CASE STUDY 

CHAIRS 

CHECKLIST 

CODES AND STANDARDS 

COLOR 

COMMUNITY 

COMPETENCE 

COMPUTER SEARCH 

CONGREGATE HOUSING 

CONTINUING CARE 

CONTINUING EDUCATION 

CONVERSIONS 

CURRICULUM 

DATA BASE 

DAY CARE 

DEATH 

DEMOGRAPHICS 

DESIGN CONSIDERATIONS 

DESIGN GUIDELINES 

DESIGN STUDIO 

DINING ROOM 

DIRECTORIES 

DISASTER 

DISPLACEMENT 

DWELLING UNITS 

DYING 

ECHO HOUSING 

ELDERLY 

ELDERLY POOR 

ENVIRONMENT 

EQUIPMENT 

EQUITY 

ERGONOMICS 

EVALUATION 

FALLS 

FAMILY CAREGIVERS 

FINANCING 

FIRE SAFETY 

FLOOR PLANS 

FLOORING 



168 APPENDICES 



Information Network 



FURNISHINGS 

GERONTOLOGY 

GLARE 

GRANNY FLATS 

HALLWAYS 

HEALTH CARE 

HEALTH CARE FACILITY, 

HEARING IMPAIRMENT 

HOME CARE 

HOME EQUITY CONVERSION 

HOME SHARING 

HOSPICE 

HOSPITALS 

HOUSE-MATCHING 

HOUSING 

HOUSING OPTIONS 

HOUSING SATISFACTION 

HUD 

INDEPENDENT LIVING 

INSTITUTIONS 

KITCHEN 

LEGISLATION 

LICENSING 

LIFE-CARE 

LIGHTING 

LIVING ROOM 

LOCATION 

LONG-TERM CARE 

LONGEVITY 

LOUNGE 

MAINTENANCE 

MARKET 

MEDICINE 

MENTAL HEALTH 

MENTAL IMPAIRMENT 

MIXED OCCUPANCY 

MOBILITY IMPAIRMENT 

MULTI-USE FACILITY 

NEIGHBORHOOD ENVIRONMENT 

NURSERY SCHOOL 

NURSES STATION 



NURSING HOME 

ORGANIZATIONS 

ORIENTATION 

OUTDOOR SPACES 

PERIODICALS 

PERSONALIZATION 

PHILOSOPHY OF DESIGN 

PHYSICAL IMPAIRMENT 

PLANNING 

POLICY 

PRIVACY 

PRODUCT DESIGN 

PRODUCTS 

PROFESSIONAL DEVELOPMENT 

PROGRAMMING 

PSYCHIATRIC TREATMENT 

PSYCHOLOGY 

PUBLIC HOUSING 

PUBLIC SPACES 

PUBLICATIONS 

RECREATION 

REDUNDANT CUING 

REFERENCE 

REFUGE AREAS 

REGULATION 

REHABILITATION 

RENOVATION 

REPORT 

RESEARCH 

RESOURCES 

RETIREMENT 

RETIREMENT COMMUNITY 

SAFETY 



APPENDICES 169 



Information Network 



SECURITY 

SENIOR CENTERS 

SENSORY IMPAIRMENT 

SERVICES 

SHARED HOUSING 

SHARED SPACES 

SHOPS 

SIGNAGE 

SINGLE FAMILY DWELLINGS 

SITE 

SKILLED CARE 

SOCIAL INTERACTION 

SOCIAL SERVICES 

SOLAR 

STAIRWAY SAFETY 

STORAGE 
TACTILE 

TAPE 

TECHNICAL PAPER 

TECHNOLOGY 

TEMPERATURE 

TENANT ELIGIBILITY 



TENANT SELECTION 

TEXTURE 

TRAFFIC PATTERNS 

TRANSPORTATION 

TRAVEL 

UNIVERSITY 

VIEW 

VISUAL IMPAIRMENT 

WHITE HOUSE CONFERENCE 

WINDOWS 

ZONING 



INDEX 
A-B 



INDEX 171 



Bold entries are keyed to Main Entries 
in Part III: Glossary, Part I: Aging 
and the Environment, or Part II: 
Facility Types. Normal type entries 
refer to the Main Entries and barrier- 
free design standards. 



access control — see Security 

accessibility — see ANSI A117.1, 
Barrier-Free Design, Bathrooms, 
Wheelchair Accessibility, UFAS, 
and refer to barrier-free design stan- 
dards 

Accessory Apartments — also see 
Granny Flats and Site Analysis 

accidents — see Safety 

Activities — also see Activity Areas 

acoustics — see Sound Control 

Activity Areas — also see Alcoves, Arts 
& Crafts Areas, Assembly Areas, 
Balconies, Corridors, Exercise 
Areas, Laundry Facilities, Lounges, 
Multi-Purpose Rooms, Outdoor Ac- 
cess, Performing Arts Areas, Read- 
ing/Library Areas, Sun Rooms, 
Television Viewing Areas, Worship 
and Meditation Rooms and Senior 
Centers in Part II: Facility Types 

Adaptability — also see Bathrooms and 
Kitchens 

Adaptive Reuse — see Adaptive Reuse 

adjacencies — see Adjacency Matrices in 
Part II: Facility Types 

administrative offices — see Office and 
Administrative Space 

Adult Day Care — also see 
Personal Care 

advantages of aging — see Part I: 
Introduction — Aging and the 
Environment 



aging process — see Part I: Introduc- 
tion — Aging and the Environment 

alarm systems — see Communication 
Systems and Redundant Cueing 

Alcoves — also see Corridors, 

Lobby/Reception Areas, Lounges, 
and Space Hierarchy 

Alzheimer's Disease — see Senile 
Dementia 

ANSI 117.1 — also see Barrier-Free 

Design, Bathrooms and UFAS 

Architectural Hardware — also see 
Barrier-Free Design, Doors, Win- 
dows, and refer to barrier-free design 
standards 

Area Requirements — also see Space 
Hierarchy 

Arts & Crafts Areas — also see Activity 
Areas and Lighting 

Assembly Areas — also see Activity 
Areas, Barrier-Free Design, Dining 
Areas, Lounges, Multi-Purpose 
Rooms, Seating, Senior Centers in 
Part II: Facility Types, and refer to 
barrier-free design standards 

attended shower — see Central Bathing 

attended toilet — Toilet Rooms 

auditoriums — see Assembly Areas 



B 

Balconies — also see Activity Areas, 
Outdoor Access, Site Development 
and Elderly Housing in Part II: 
Facility Types 

barber shops — see Shops 

Barrier-Free Design — also see 

Adaptability, ANSI 117.1, Control, 
UFAS and Part I: Introduction — 
Aging and the Environment 

bathing, central — see Central Bathing 



1 72 INDEX 



B-C 



Bathrooms, Private — also see Barrier- 
Free Design, Central Bathing, Con- 
gregate Housing, Communication 
Systems, Doors, Toilet Rooms, 
Elderly Housing in Part II: Facility 
Types, and refer to barrier- free design 
standards 

bathtubs — see Bathrooms and Central 
Bathing 

beauty shops — see Shops 

Bedrooms, Housing — also see 

Furnishability, Privacy, Television 
Viewing Areas, Windows and Elder- 
ly Housing in Part II: Facility 
Types 

Beds — also see Residents' Rooms 

Board and Care Facilities — see Residen- 
tial Care Facilities in Part II: Facili- 
ty Types 

building circulation — see Wayfinding 

building entries — see Entries 

building exits — see Exits 

building orientation — see Site 
Development 



cabinets — see Kitchens 

call systems — see Communication 
Systems 

care options — see Adult Day Care, 
Home Care, Hospice Care, Nursing 
Care, Personal Care, Respite Care, 
and Residential Care Facilities and 
Continuing Care Retirement Com- 
munities in Part II: Facility Types 

care services — see Personal Care and 
Nursing Care 

carpeting — see Finishes 

ceilings — see Finishes 

Central Bathing — also see Bathrooms, 
Toilet Rooms and Nursing Homes in 
Part II: Facility Types 



central food service — see Dining Areas, 

Entries, Kitchens and Snack Bars 
central laundry — see Housekeeping 
chairs — see Assembly Areas and 

Seating 
chapel — see Worship and Meditation 

Room 
characteristics of aging — see Part I: 

Introduction — Aging and the 

Environment 
charting counter — see Nursing Station 
clean and soiled utility rooms — see 

Nursing Homes in Part II: Facility 

Type 

closets — see Storage 

cognitive changes — see Part I: 
Introduction — Aging and the 
Environment 

color — see Part I: Introduction — Aging 
and the Environment 

comfort level — see HVAC and Part I: 
Introduction — Aging and the 
Environment 

Communication Systems — also see 
Barrier-Free Design, Bathrooms, 
Lighting, Nursing Station, Office 
and Administrative Space, Redun- 
dant Cueing, Nursing Homes in 
Part II: Facility Types, and refer to 
barrier-free design standards 

community centers — see Continuing 
Care Retirement Communities and 
Senior Centers in Part II: Facility 
Types 

Community Spaces — also see Activity 
Areas and Space Hierarchy 

Congregate Housing — also see 

Bathrooms, Emergency Care and 
Housekeeping 

Consultation Room — also see Emer- 
gency Care, Examination & Treat- 
ment Room, Nursing Care, and 
Senior Centers in Part II: Facility 
Types 



INDEX 173 



C-E 



Continuing Care Retirement Com- 
munities — see Part II: Facility 
Types 

Continuum of Care — also see Long- 
Term Care, and Continuum of 
Care, Residential Care Facilities and 
Continuing Care Retirement Com- 
munities in Part II: Facility Types 

Control — also see Barrier-Free Design, 
HVAC, Security, Space Hierarchy, 
Windows, and refer to barrier-free 
design standards 

controls — see Elevators, HVAC and 
Windows 

cooking equipment — see Kitchens 

cooling — see HVAC 

Corridors — also see Activity Areas, 
Alcoves, Handrails, Lighting, Way- 
finding and Windows 

counseling — see Social Services 

counter tops — see Kitchens 

curb cuts — refer to barrier-free design 
standards 

D 

day care — see Adult Day Care 

day rooms — see Lounges 

demographics — see Part I: Introduc- 
tion — Aging and the Environment 
Dining Areas — also see Assembly 
Areas, Finishes, Kitchens, Lounges, 
Outdoor Access, Residents' Rooms, 
Seating and Toilet Rooms 

dining, communal — see Dining Areas 

directories — see Sign Systems and 
Wayfinding 

display — see Arts and Crafts Areas and 
Residents' Rooms 

Doors — also see Architectural Hard- 
ware, Barrier-Free Design, Bath- 
rooms, Central Bathing, Entries, 
Residents' Rooms, Sign Systems, 
and refer to barrier-free design 
standards 



door hardware — see Architectural 

Hardware 
door signage — see Entries and Sign 

Systems 
dressing area — see Central Bathing, 

Consultation Room and Residents' 

Rooms 
drives — see Site Development 
dwelling unit — see Entries, Elderly 

Housing in Part II: Facilities Types 

and specific rooms and spaces 

E 

Echo Housing — see Granny Flats 

electrical outlets — refer to barrier-free 
design standards 

Elevators — also see Barrier-Free 
Design, and refer to barrier-free 
design standards 

emergency access — see Bathrooms 

emergency call systems — see Com- 
munication Systems 

Emergency Care — also see Congregate 
Housing and Nursing Home in Part 
II: Facility Types 

energy conservation — see HVAC 

Entries — also see Lobby/Reception 
Areas and Site Development 

environmental control — see Control 
and HVAC 

equipment — see Control and under 
specific room or space, and refer to 
barrier-free design standards 

Examination and Treatment Room 
— also see Consultation Room, Nurs- 
ing Care and Nursing Home in Part 
II: Facility Types 

Exercise Areas — also see Activity Areas 
and Outdoor Spaces 

Exits — also see Safety 



174 INDEX 



FJ 



Finishes — also see Central Bathing, 
Corridors, and Residents' Rooms 

fire safety — see Safety 

floor finishes — see Finishes 

floor plan — see Wayfinding 

food service — see Dining Areas, 
Kitchens and Snack Bars 

foyer — see Entries 

front desk — see Lobby /Reception 
Areas 

functional status — see Part I: 
Introduction — Aging and the Envi- 
ronment 

Furnishability — also see Bedrooms, 
Living/Dining Rooms and 
Residents' Rooms 

furnishings — see Control, Lighting, 
Sign Systems and specific room or 
space 

furniture — see Beds, Furnishability, 
Seating and specific room or space 



Handrails — also see Alcoves, Barrier- 
Free Design, Corridors, Elevators, 
Ramps, Stairs, and refer to barrier- 
free design standards 

hearing — see Part I: Introduction — 
Aging and the Environment 

Heating, Ventilation and Air- 
Conditioning — also see Control 

Home Care — also see Nursing Homes 
in Part II: Facility Types 

Hospice Care — also see Nursing 

Homes in Part II: Facility Types 

Housekeeping — also see Entries, Laun- 
dry Facilities, Residential Services 
and Residential Care Facilities in 
Part II: Facility Types 

housing options — see Accessory Apart- 
ments, Congregate Housing, 
Granny Flats, Group Homes, and 
Residential Care Facilities' Contin- 
uing Care Retirement Communities 
and Elderly Housing 
in Part II: Facility Types 

hydrotheraphy — see Therapy Rooms 



game rooms — see Activity Areas 
gardens — see Site Development 
glare — see Corridors, Lighting, Sign 

Systems and Windows 
grab bars — see Bathrooms, Central 

Bathing, Toilet Rooms and refer to 

barrier-free design standards 
Granny Flats — also see Accessory 

Apartments and Site Analysis 
graphics — see Sign Systems 
Group Homes — also see specific rooms 

or spaces such as Kitchens 

H 

handicapped — see Barrier-Free 
Design, and refer to barrier-free 
design standards 



impairment — see Part I: Introduc- 
tion — Aging and the Environment 

independent housing — see Elderly 
Housing in Part II: Facility Types 

information and referral — see Social 
Services 

information center — see Lobby/Recep- 
tion Areas 

interior finishes — see Finishes 



janitor's closet — see Housekeeping 



INDEX 175 



KM 



K 

Kitchens — also see Congregate Hous- 
ing, Group Homes, Snack Bars, and 
Senior Centers, Continuing Care 
Retirement Communities and Nurs- 
ing Homes in Part II: Facility 
Types 



landmarks — see Site Development and 
Wayfinding 

landscaping — see Site Development and 
Seating 

Laundry Facilities — also see Activity 
Areas, Housekeeping, and refer to 
barrier-free design standards 

Lighting — also see Arts and Crafts 
Areas, Corridors, Site Development, 
Windows and specific room or space 

Living/Dining Room — also see 

Balconies, Furnishability, Outdoor 
Access, Television Viewing Areas, 
Windows and Elderly Housing in 
Part II: Facility Types 

loading areas — see Entries 

Lobby/Reception Areas — also see 
Alcoves, Communication Systems, 
Elevators, Entries, Lounges, Mail 
and Package Delivery, 
Outdoor Access, Sign Systems and 
Toilet Room 

location — see Site Analysis 

Long-Term Care — also see Continuum 
of Care, Home Care, Nursing 
Care, and Continuing Care Retire- 
ment Communities and Nursing 
Homes in Part II: Facility Types 



Lounges — also see Activity Areas, 
Alcoves, Assembly Areas, Consulta- 
tion Rooms, Corridors, Dining 
Areas, Finishes, Lobby/Reception 
Areas, Nursing Station, Outdoor 
Access, Sound Control, Space Hier- 
archy, Television Viewing Areas, 
Toilet Rooms, and Nursing Homes 
in Part II: Facility Types 

M 

Mail and Package Delivery — also see 
Lobby/Reception Areas 

maintenance — see Housekeeping 

market — see Part I: Introduction — 
Aging and the Environment 

meals-on-wheels — see Kitchens 

Medication Room — also see Nursing 
Home in Part II: Facility Types 

meeting rooms — see Assembly Areas 
and Multi-Purpose Room 

mental impairment — see Senile Demen- 
tia and Part I: Introduction — Aging 
and the Environment 

Minimum Property Standards 

— HUD — see Area Requirements 

mirrors — see Bathrooms and Central 
Bathing 

Mobile Homes — also see Granny Flats 

mobility — see Part I: Introduction — 
Aging and the Environment, and 
refer to barrier-free design standards 

multi-level care facilities — see Continu- 
ing Care Retirement Communities 
in Part II: Facility Types 

Multi-Purpose Rooms — also see Activ- 
ity Areas, Assembly Areas 
and Senior Centers in Part II: 
Facility Types 

music areas — see Activity Areas, 
Assembly Areas, Multi-Purpose 
Rooms, Performing Arts Areas, and 
Senior Centers in Part II: Facility 
Types 



176 INDEX 



N-P 



N 



neighborhood — see Site Analysis 

Nourishment Station — also see 
Kitchens and Nursing Homes in 
Part II: Facility Types 

nurses' lounge/toilet — see Nursing 
Homes in Part II: Facility Types 

Nursing Care — also see Consultation 
Room, Examination and Treatment 
Room, Home Care, Long-Term 
Care, Medication Room, Nursing 
Station, Personal Care, Social Ser- 
vices, Therapy Room and Nursing 
Homes in Part II: Facility Types 

Nursing Homes — see Part II: Facility 
Types 

Nursing Station — also see Medication 
Room, Vigil/ Visitation Room, and 
Nursing Home in Part II: Facility 
Types 

nursing unit — see Nursing Homes in 

Part II: Facility Types 



O 



occupational therapy — see Therapy 
Room 

Office and Administrative Space — also 
see Activity Areas, Communication 
Systems, Community Spaces, Eleva- 
tors, Lobby/ Reception Areas, 
Lounges, Multi-Purpose Rooms, and 
Elderly Housing and Senior Centers 
in Part II: Facility Types 

organic brain syndrome — see Senile 
Dementia 

orientation — see Corridors, Redundant 
Cueing, Sign Systems, Site Develop- 
ment and Wayfinding 



Outdoor Access — also Balconies, Site 
Development, Sun Rooms, Windows 

and specific room or space 
outdoor spaces — see Balconies, Out- 
door Access, Seating and Site 
Development 
ovens — see Kitchens 



parking — see Site Development and 
refer to barrier-free design standards 

patios — see Outdoor Access and Site 
Development 

Performing Arts Areas — also see 

Activity Areas, Assembly Areas, and 
Senior Centers in Part II: Facility 
Types 

Personal Care — also see Adult Day 
Care, and Continuing Care Retire- 
ment Communities and Residential 
Care Facilities in Part II: Facility 
Types 

personalization — see Residents' Rooms 

pets — see Activities and Site Develop- 
ment 

physical therapy — see Therapy Rooms 

plumbing fixtures — see Bathrooms, 
Central Bathing, Kitchens and 
Toilet Rooms 

Privacy — also see Bathrooms, 
Bedrooms, Central Bathing, 
Residents' Rooms, Space Hierarchy, 
and Nursing Homes in Part II: 
Facility Types 

private kitchen/dining — see Kitchens, 
Living/Dining Rooms 

psychological changes — see Part I: 
Introduction — Aging and the Envi- 
ronment 

public restrooms — see Toilet Rooms 

public spaces — see Corridors and 
Wayfinding 



INDEX 177 



R-S 



R 

Ramps — also see Barrier-Free Design, 
Handrails, and refer to barrier-free 
design standards 

range — see Kitchens 

Reading/Library Areas — also see 

Activity Areas, Lighting and Seating 

receiving — see Housekeeping 

Redundant Cueing — also see Com- 
munication Systems and Wayfinding 

reflections — see Lighting and Finishes 

refrigerator/freezer — see Kitchens 

Residential Services — also see Con- 
gregate Housing, Dining Areas, 
Housekeeping, Kitchens, Nourish- 
ment Stations, Shops, Snack Bars, 
and Senior Centers and Continuing 
Care Retirement Communities in 
Part II: Facility Types 

Residents' Rooms — also see Beds, Con- 
trol, Dining Areas, Doors, Furnish- 
ability, HVAC, Lighting, Seating, 
Toilet Rooms, Windows, and Nurs- 
ing Homes in Part II: Facility 
Types 

Respite Care — also see Residential 
Care Facilities and Nursing Homes 
in Part II: Facility Types 

Retirement Communities — see also 
Continuing Care Retirement Com- 
munities in Part II: Facility Types 



Safety — also see Balconies, Bathrooms, 
Beds, Communication Systems, 
Exits and HVAC 

Seating — also see Activity Areas, 
Assembly Areas, Dining Areas, 
Lounges, Ramps, Site Development, 
Stairs 



Security — see also Communication 
Systems, Site Analysis and Site 
Development 

semi-independent housing — see Con- 
gregate Housing 

Senile Dementia — also see Part I: 
Introduction — Aging and the Envi- 
ronment 

Senior Centers — see Senior Centers in 
Part II: Facility Types 

service entry — see Entries 

service- supported housing — see Con- 
gregate Housing 

shared housing — see Group Homes 

shelter — see Site Development 

shelving — see Kitchens 

Shops — also see Barrier-Free Design, 
Congregate Housing, Lighting, 
Residential Services, and Senior 
Centers and Nursing Homes in Part 
II: Facility Types 

shower, attended — see Central Bathing 

showers — see Bathrooms 

Sign Systems — also see Barrier-Free 
Design, Entries, Lighting, 
Lobby/Reception Areas, Wayfinding 
and refer to barrier-free design stan- 
dards 

Single Room Occupancy (SRO) — see 
Part II: Facility Types 

sinks — see Kitchens 

Site Analysis — also see Accessory 
Apartments, Area Requirements, 
Security and Site Development 

Site Development — also see Activity 
Areas, Balconies, Barrier-Free 
Design, Community Spaces, 
Entries, Exits, Lighting, Outdoor 
Access, Seating, Sign Systems, Site 
Analysis, Wayfinding, and refer to 
barrier-free design standards 



178 INDEX 



s-u 



Snack Bars — also see Barrier-Free 
Design and Residential Services 

social characteristics — see Part I: Intro- 
duction — Aging and the Environ- 
ment 

Social Services — also see Office and 
Administrative Space 

solar orientation — see Site Development 

Sound Control — also see Residents' 
Rooms 

Space Hierarchy — also see Alcoves, 
Community Spaces, Congregate 
Housing, Control, Privacy, 
Residents' Rooms, and Residential 
Care and Nursing Homes in Part II: 
Facility Types 

Stairs — also see Barrier-Free, Hand- 
rails, and refer to barrier-free design 
standards 

Storage — also see Arts and Crafts 
Areas, Kitchen, Residents' Rooms, 
and Elderly Housing and Nursing 
Homes in Part II: Facility Types 

stove — see Kitchens 

Sun Rooms — also see Activity Areas, 
Balconies, Outdoor Access and Site 
Development 



Tactile Cues — also see Redundant Cue- 
ing, Stairs, and refer to barrier-free 
design standards 

tactile sensitivity — see Part I: Introduc- 
tion — Aging and the Environment 

telephones — see Communication 
Systems 

Television Viewing Areas — also see 
Activity Areas, Bedrooms, Liv- 
ing/Dining Rooms, Lounges and 
Residents' Rooms 



Therapy Room — also see Nursing 
Care, and Nursing Homes in Part 
II: Facility Types 

thermal sensitivity — see HVAC, 

Residents' Rooms and Part I: Intro- 
duction — Aging and the Environ- 
ment 

thresholds — see Doors and Entries 

toilet accessories — see Bathrooms, Cen- 
tral Bathing and Toilet Rooms 

Toilet Rooms — also see Barrier-Free 
Design, Bathrooms, Dining Areas, 
Doors, Lighting, Lounges, 
Residents' Rooms, and refer to 
barrier-free design standards 

toilets — see Bathrooms, Toilet Rooms 
and refer to barrier-free design 
standards 

topography — see Site Analysis 

transportation — see Site Analysis 

trash storage and removal — see Entries 
and Housekeeping 

tubs — see Bathrooms and Central 
Bathing 



U 

Uniform Federal Accessibility Stan- 
dards (UFAS) — also see Adaptabili- 
ty, ANSI 117.1 and Barrier-Free 
Design 

utilities — see Site Analysis 

U.S. Architectural and Transportation 
Barriers Compliance Board — see 
Barrier- Free Design, Annotated 
Bibliography 



INDEX 179 



v-z 



vending machines — see Snack Bars 

ventilation — see Elevators, HVAC and 
Kitchens 

vision — see Part I: Introduc- 
tion — Aging and the Environment. 

Vigil/Visitation Room — also see Nurs- 
ing Homes in Part II: Facility 
Types 

visual access — see Arts and Crafts 
Areas, Community Spaces and 
Space Hierarchy 



W 



waiting lounge — see Entries and 
Lounges 

walkways — see Site Development 

Wayfinding — also see Corridors, 
Redundant Cueing, Sign Systems 
and Site Development 

wellness center — see Continuum of 
Care in Part II: Facility Types 

Wheelchair Accessibility — also see 
Ramps, and refer to barrier- free 
design standards 

Windows — also see Architec- 
tural Hardware, Barrier-Free 
Design, Bedrooms, Corridors, 
Lighting, Outdoor Access and 
specific rooms or spaces 

Worship and Meditation Room — also 
see Activity Areas 



zoning — see Site Analysis 



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